Method and apparatus for wrist arthroplasty

ABSTRACT

A prosthesis can replace at least a portion of an anatomical wrist. The prosthesis can include modular portions and bone ingrowth portions for fixation. The modular prosthesis can include selected portions that are assembled for implantation.

CROSS-REFERENCE TO RELATED APPLICATIONS

This application is a continuation-in-part of U.S. patent applicationSer. No. 11/517,537 filed on Sep. 7, 2006, which is acontinuation-in-part of U.S. patent application Ser. No. 11/260,729filed on Oct. 27, 2005, which is a continuation-in-part of U.S. patentapplication Ser. No. 10/862,821 filed on Jun. 7, 2004, which is acontinuation-in-part of U.S. patent application Ser. No. 10/279,240filed on Oct. 24, 2002 now U.S. Pat. No. 6,746,486. The disclosures ofeach of the above applications are incorporated herein by reference.

FIELD

The present teachings generally relate to prosthetic implants and moreparticularly to prosthetic wrist implants.

BACKGROUND

With reference to FIG. 1 of the drawings, the dorsal side of the bonestructure of a patient's left hand and wrist is illustrated inconjunction with the radius 2 and the ulna 4. The bone structureincludes a carpal bone complex 6 having a scaphoid 8, a lunate 10, atriquetrum 12, a pisiform 14, a trapezium 16, a trapezoid 18, a capitate20 and a hamate 22. It will be appreciated that the scaphoid 8 and thelunate 10 bones articulate with the radius 2 during the movement of thewrist.

In a variety of wrist disorders, patients may experience discomfort,pain and difficulty in moving the wrist. Prior surgical treatment ofthis condition involved fusion to inhibit movement of the scaphoid 8 andthe lunate 10 bones relative to the radius to thereby alleviate pain inthe patient's wrist. This procedure, however, leaves the patient withoutmotion in their wrist and thereby severely restricts the use of theirwrist. Prosthetic wrist implants have been developed to provide a pairof artificial bearing surfaces for the wrist. Several of the prior wristimplants have suffered from drawbacks including limited range of motionand excessive bone resection. Others still provide proper motion onlywhen aligned in an extremely precise manner relative to the carpal bonecomplex 6. While various jigs and fixtures may be employed to aid in thelocating and forming of a hole in the distal portion of the carpal bonecomplex 6 for receiving a carpal implant, these devices typically do notcompletely eliminate the possibility of error in the alignment andforming of the hole.

Accordingly, there remains a need in the art for an improved prostheticwrist implant that provides improved support and strength for the distalportion of the carpal bone complex 6 and which has a bearing surfacewhose orientation is changeable after implantation to provide theimplanted prosthetic wrist with a range of motion that mimics the rangeof motion of a natural wrist.

SUMMARY

An implant for a wrist arthroplasty, such as a total orhemi-arthroplasty, is disclosed. Various embodiments include providing ahemi-arthroplasty included for either replacing the distal portions ofthe radius, ulna or both to articulate with natural portions of thecarpal bone complex. Also, a hemi-arthroplasty prosthesis that includesreplacing portions of only the carpal bone complex is disclosed.Alternatively, an arthroplasty may occur regarding the radius or ulnabones and the carpal bones to provide a substantially complete wristarthroplasty. In addition, both the carpal bone complex prosthesis andthe radius and ulna prosthesis may include substantially modularportions such that selections may be made during an operative procedureto assist in providing a substantially best fit or customized implantfor a selected patient. In addition, various portions of the prosthesismay include parts to replace complete bones of the carpal bone complexor other anatomical portions to assist in providing a substantiallynatural articulation and range of motion of the wrist after theprocedure.

According to various embodiments, a modular prosthesis for placement ina wrist relative to a radius is disclosed. A distal radial assembly mayinclude a stem portion operable to be positioned relative to a portionof the radius and a distal radial segment operable to be interconnectedwith the stem portion during an operative procedure. The stem portionand the distal radial segment are provided to be interconnected tosubstantially form a portion of a radial articulation with a carpalcomplex.

According to various embodiments, a modular prosthesis for placement ina wrist is disclosed. A distal radial assembly including a stem portionoperable to be positioned within a portion of a radius and a distalradial segment operable to be interconnected with the stem portionduring an operative procedure. The modular prosthesis may also include acarpal implant operable to be interconnected with a portion of the wristto articulate with the distal radial implant. The stem portion and thedistal radial segment are provided to be interconnected to substantiallyform a portion of a radial articulation with a carpal complex.

According to various embodiments, a kit for performing an arthroplastyrelative to the wrist joint including the radius and the carpal complexis disclosed. A stem member operable to be positioned relative to theradius having a stem connection portion may be provided. A distal radialsegment may also be included having a segment connecting portionoperable to be associated with the stem member. A carpal implant may beprovided to be associated with the carpal complex. Also, a bearingmember may be disposable between the distal radial segment and thecarpal complex implant. At least two of the stem member, the distalradial segment, the carpal complex implant; and the bearing member areassociated to perform the arthroplasty.

According to various embodiments a method of performing a wristarthroplasty relative to a radius and a carpal complex. The methodincludes forming an incision relative to the wrist and determining anarthroplasty to be performed for the wrist arthroplasty. Also a stemmember and a distal radial segment may be selected. The selected stemmember and the distal radial segment may be interconnected. Each of themembers may be positioned in the anatomy and the stem member may bepositioned relative to the radius.

According to various embodiments, a prosthesis to replace a portion of abone is disclosed. The prosthesis can include a stem member extendingbetween a first end and a second end wherein the second end is operableto extend into the bone and an articulation assembly. The articulationassembly can include a stem connection portion to interconnect with thefirst end of the stem member and held relative to the bone, anarticulation portion operable to extend from the stem connectionportion, and a connection portion operable to interconnect the stemconnection portion and the articulation portion. The articulationportion can form an articulation assembly with a second member.

According to various embodiments, a prosthesis to replace a portion of abone is disclosed. The prosthesis can include a first member operable toengage a carpal bone including a carpal bone facing surface having atleast two flat surfaces and a second member assembly. The second memberassembly can include a first portion formed of a hard material and asecond portion formed of a soft material that is softer than the hardmaterial. The first member and the second member can be connected.

According to various embodiments, a prosthesis to replace a portion of abone is disclosed. The prosthesis can include a first portion operableto be connected to a first bone, the first portion includes a stemmember that can extend into the first bone and an articulation memberthat can extend distally from the first bone, wherein the articulationmember can be formed of a metal material. The prosthesis can furtherinclude a second portion that can be connected to a second bone, thesecond portion includes a first member formed of a hard material and asecond member formed of a soft material that can be softer than the hardmaterial. The second member can form an articulation with thearticulation member.

Further areas of applicability of the present teachings will becomeapparent from the detailed description provided hereinafter. It shouldbe understood that the detailed description and various examples, whileindicating the various embodiments of the teachings, are intended forpurposes of illustration only and are not intended to limit the scope ofthe teachings or the claims.

BRIEF DESCRIPTION OF THE DRAWINGS

Additional advantages and features of the present invention will becomeapparent from the subsequent description and the appended claims, takenin conjunction with the accompanying drawings, wherein:

FIG. 1 is a view of the dorsal side of a patient's left hand and wristillustrating the bone structure of the hand and wrist in conjunctionwith the radius and the ulna;

FIG. 2 is a view of the dorsal side of a patient's left hand and wristillustrating the implantation of a prosthetic wrist implant constructedin accordance with the teachings of the present invention;

FIG. 3 is an exploded view of a prosthetic wrist constructed inaccordance with the teachings of the present invention;

FIG. 4 is a perspective view of a portion of the prosthetic wrist ofFIG. 2 illustrating the carpal implant in greater detail;

FIG. 5 is a side view of a portion of the prosthetic wrist of FIG. 2illustrating the wrist bearing component in the coronal plane;

FIG. 6 is a side view of a portion of the prosthetic wrist of FIG. 2illustrating the wrist bearing component in the sagittal plane;

FIG. 7 is an exploded perspective view of a prosthetic wrist similar tothat of FIG. 2 but additionally including an alignment mechanism forradially fixing the wrist bearing component relative to the carpalimplant;

FIG. 8 is an exploded view in partial section of a prosthetic wristconstructed in accordance with the teachings of a second embodiment ofthe present invention;

FIG. 9 is a view of a kit that utilizes the prosthetic wrist of FIG. 8;

FIG. 10 is a side elevation view of a carpal implant constructed inaccordance with the teachings of a third embodiment of the presentinvention;

FIG. 11 is a side elevation view of a carpal implant constructed inaccordance with the teachings of a fourth embodiment of the presentinvention;

FIG. 12 is a side elevation view of a carpal implant constructed inaccordance with the teachings of a fifth embodiment of the presentinvention;

FIG. 13 is an exploded front elevation view of a portion of a prostheticwrist constructed in accordance with the teachings of a sixth embodimentof the present invention;

FIG. 14 is a side elevation view of a portion of the prosthetic wrist ofFIG. 13;

FIG. 15 is an exploded side elevation view of a prosthetic wristconstructed in accordance with the teachings of a seventh embodiment ofthe present invention;

FIG. 16 is an exploded side elevation view of a prosthetic wristconstructed in accordance with the teachings of an eighth embodiment ofthe present invention;

FIG. 17 is an exploded perspective view of a prosthetic wristconstructed in accordance with the teachings of a ninth embodiment ofthe present invention;

FIG. 18 is an exploded side elevation view of the prosthetic wrist ofFIG. 17;

FIG. 19 is an exploded perspective view of a prosthetic wristconstructed in accordance with the teachings of a tenth embodiment ofthe present invention;

FIG. 20 is an exploded side elevation view of the prosthetic wrist ofFIG. 19;

FIG. 21 is an exploded side elevation view of a prosthetic wristconstructed in accordance with the teachings of an eleventh embodimentof the present invention;

FIG. 22 is an exploded side perspective view of the prosthetic wrist ofFIG. 21;

FIG. 21A is an exploded side elevation view of a prosthetic wristconstructed in accordance with the teachings of various embodiments ofthe present invention;

FIG. 22A is an exploded perspective view of the prosthetic wrist of FIG.21A;

FIG. 23 is an exploded side elevation view of a prosthetic wristconstructed in accordance with the teachings of a twelfth embodiment ofthe present invention;

FIG. 24 is an exploded side elevation view of a prosthetic wristconstructed in accordance with the teachings of a thirteenth embodimentof the present invention;

FIG. 25 is a sectional view taken along the line 25-25 of FIG. 24;

FIG. 26 is an exploded side elevation view of a prosthetic wristconstructed in accordance with the teachings of a fourteenth embodimentof the present invention; and

FIG. 27 is a sectional view taken along the line 27-27 of FIG. 26.

FIG. 28 is a proximal-to-distal view of the carpal complex;

FIG. 29A is a plan view of a carpal implant according to variousembodiments;

FIG. 29B is a plan view of a carpal implant according to variousembodiments;

FIG. 30 is a plan view of a carpal implant according to variousembodiments;

FIG. 31 is an environmental view of the carpal implant according tovarious embodiments of FIG. 30 implanted;

FIG. 32 is a distal radial implant according to various embodiments;

FIG. 33 is a stem portion of a distal radial implant according tovarious embodiments;

FIG. 34A is a plan view of a distal radial segment of a modular distalradial implant according to various embodiments;

FIG. 34B is a perspective view of the distal radial segment of FIG. 34A;

FIG. 35A is a plan view of distal radial segment for a distal radialimplant according to various embodiments;

FIG. 35B is a perspective view of the distal radial segment of FIG. 35A;

FIG. 36A is a plan view of a distal radial segment implant according tovarious embodiments;

FIG. 36B is a perspective view of the distal radial implant of FIG. 36A;

FIG. 37 is an environmental view of the distal radial implant of FIG.36A in an implanted position;

FIG. 38A is a distal radial segment of the distal radial implantaccording to various embodiments;

FIG. 38B is a perspective view of the distal radial segment of FIG. 38A;

FIG. 39A is a plan view of a bearing portion for a distal radial segmentaccording to various embodiments;

FIG. 39B is a perspective view of the bearing portion of FIG. 39Aaccording to various embodiments;

FIG. 40A is a plan view of a bearing portion for a distal radial implantaccording to various embodiments;

FIG. 40B is a perspective view of the bearing portion of FIG. 40A;

FIG. 41 is a perspective view of a distal radial implant according tovarious embodiments;

FIG. 42 is a perspective view of a distal radial implant according tovarious embodiments;

FIG. 43 is an environmental view of the distal radial implant of FIG. 42according to various embodiments in an implanted position;

FIG. 44 is a kit view of various embodiments of the present invention.

FIG. 45 is an environmental view of a hemi-arthroplasty replacing aportion of a carpal complex according to various embodiments;

FIG. 46 is a plan view of a distal radial replacement according tovarious embodiments;

FIG. 47 is a top plan view of the device illustrated in FIG. 46;

FIG. 48 is a end elevation view of a distal radial replacement accordingto various embodiments;

FIG. 49 is a side elevation view of a distal radial replacementaccording to various embodiments;

FIG. 50 is a perspective detail environmental view of a distal radialimplant according to various embodiments;

FIG. 51 is a plan view of a kit including various components for a bonereplacement system;

FIG. 52 is an environmental view of preparing an anatomical portion fora bone replacement;

FIG. 53 is an environmental view of the portion of an anatomy resectedfor a bone replacement implant according to various embodiments;

FIG. 54 is an environmental view illustrating a positioning of a portionof an implant according to various embodiments;

FIG. 55 is an environmental view of an implant positioned relative to aportion of the anatomy according to various embodiments;

FIG. 56 is an exploded perspective view of a distal radial prosthesisaccording to various embodiments;

FIG. 57 is an environmental perspective view of the distal radialprosthesis of FIG. 56;

FIG. 58A is an exploded perspective view of a distal radial prosthesisaccording to various embodiments;

FIG. 58B is an assembled perspective view of a distal radial prosthesisaccording to various embodiments;

FIG. 59A is an environmental perspective view of a distal radialprosthesis according to various embodiments;

FIG. 59B is an environmental perspective view of a distal radialprosthesis according to various embodiments substantially implantedrelative to a radius;

FIG. 60 is an exploded perspective view of a wrist prosthesis, accordingto various embodiments; and

FIG. 61 is a plan view of a bearing component, according to variousembodiments.

DETAILED DESCRIPTION OF VARIOUS EMBODIMENTS

The following description of various embodiments is merely exemplary innature and is not intended to limit the teachings, application, or usesof various embodiments.

With reference to FIGS. 2 and 3 of the drawings, a prosthetic wristconstructed in accordance with the teachings of the present invention isgenerally indicated by reference numeral 50. The prosthetic wrist 50 isillustrated in a post operative condition as implanted to a distalportion 2 a of the radius 2 and a proximal portion 6 a of the carpalbone complex 6. As those skilled in the art will appreciate, the distalportion 2 a of the radius 2 and the proximal portion 6 a of the carpalbone complex 6 are formed when the surgeon resects a portion of theradius 2 and the carpal bone complex 6 from the patient prior toimplantation of the prosthetic wrist 50.

The prosthetic wrist is illustrated to include a radial implant 52, acarpal implant 54, a wrist bearing component 56 and a plurality of bonescrews 58. The radial implant 52 includes a radial stem 60, which isconfigured to be implanted into a distal portion 2 a of the radius 2,and a bearing guide 62, which is fixed to the distal end of the radialstem 60. The bearing guide 62 includes a bearing or concave guidesurface 64 that is configured to engage in a mating manner the wristbearing component 56. In the preferred embodiment, the radial implant 52is unitarily formed from a titanium material, such as Ti-6AI-4V (F136),although those skilled in the art will understand that other materialshaving sufficient strength and biocompatibility may also be employed.Those skilled in the art will also understand that the radial implant 52may be configured in a modular manner, wherein the radial stem 60 andthe bearing guide 62 are discrete elements that are coupled togetherprior to or during the process of implantation. It will also beunderstood that the bearing guide 62 may be integrally formed or moldedonto the radial implant 52 and formed of a selected material. Forexample, the bearing guide 62 may be formed of a polyethylene materialor other polymer to be formed with the radial stem 60. Therefore theradial implant 52 may include a proximal radial stem on a distal radialportion over which the bearing guide portion 62 is formed. Nevertheless,as discussed above, the bearing guide portion 62 may be formed of anyappropriate material such as a ceramic, or a metal including titaniumand cobalt chromium molybdenum alloy.

With additional reference to FIGS. 3 and 4, the carpal implant 54 isillustrated to include a body 70, a ulnar flange 72 and a radial flange74. The carpal implant 54 is unitarily formed from a titanium material,such as Ti-6AI-4V (F136), although those skilled in the art willunderstand that other materials having sufficient strength andbiocompatibility may also be employed.

The body 70 includes a stem 80, a proximal stem 82 and aninterconnecting flange 84. The stem 80, which is formed along a stemaxis 86 and extends from the distal side of the body 70, is configuredto be inserted into a hole formed in the capitate 20 (FIG. 2). Theproximal stem 82 extends in a direction opposite the stem 80 and issized to engage the wrist bearing component 56. In the particularembodiment illustrated, the proximal stem 82 is formed as a taperedcylinder having an axis 88 that is offset ulnarly from the stem axis 86.Those skilled in the art will appreciate, however, that the axis 88 ofthe proximal stem 82 may be coincident with the stem axis 86. The taperof the proximal stem 82 is configured to the profile of a conventionalMorse taper for attachment to the wrist bearing component 56. A filletradius R is employed to reduce the concentration of stress at the pointsat which the stem 80 and the proximal stem 82 are joined to theremainder of the body 70.

The interconnecting flange 84 couples the stem 80 to the ulnar flange72. The interconnecting flange 84 includes an interconnecting boneabutment surface 90 that is skewed to the stem axis 86 by an angle thatis less than 90 degrees in magnitude and which is preferably about 80degrees to permit the interconnecting flange 84 to conform to theproximal end of the distal portion 6 a of the carpal bone complex 6.

The ulnar flange 72 is coupled to a side of the interconnecting flange84 proximate the stem 80 and has a lateral bone abutment surface 96 thatis configured to abut an ulnar side of the hamate 22 and which projectsupwardly from the body 70 in a manner that is skewed to both the stemaxis 86 and the interconnecting bone abutment surface 90 by an angle ofless than 90 degrees. A securing aperture 98 a, which is formed in thedistal end of the ulnar flange 72 along an axis that is generallyperpendicular to the lateral bone abutment surface 96, is illustrated toinclude a first portion 100 and a second portion 102. Although it willbe understood that a perpendicular aperture is not required. The firstportion 100 of the securing aperture 98 a has a spherical shape that isconfigured to matingly engage the frusto-conical surface of the head 58a of a bone screw 58. (FIG. 3). The second portion 102 of the securingaperture 98 a has a generally cylindrical shape that is sized to receivethe body 58 b of the bone screw 58.

In the particular embodiment illustrated, the ulnar bone abutmentsurface 96 is arranged at an angle of about 50 degrees relative to thestem axis 86. The distal end of the ulnar flange 72 terminates at anarcuate edge 104 that is defined by a radius that is centered at thecenterpoint of the securing aperture 98 a. As those skilled in the artwill readily appreciate, however, the center of the radius need not becentered at the centerpoint of the securing aperture 98 a.

The radial flange 74 is coupled to the body 70, and more specifically tothe interconnecting flange 84, on a side opposite the ulnar flange 72and includes a medial bone abutment surface 110 that is configured toabut a radial side of the distal portion 6 a of the carpal bone complex6 and which projects upwardly from the body 70 in a manner that isskewed to the stem axis 86 by an angle of less than 90 degrees. In theparticular embodiment illustrated, the radial bone abutment surface 110is skewed to the stem axis 86 by an angle of about 80 degrees. Like theulnar flange 72, the radial flange 74 includes a securing aperture 98 band terminates at its distal end at an arcuate edge 112 that is definedby a radius that is centered at the centerpoint of the securing aperture98 b. The securing aperture 98 b is substantially identical to thesecuring aperture 98 a but is formed about an axis that is generallyperpendicular to the radial bone abutment surface 110.

In view of the above discussion, those skilled in the art willappreciate that one general concept of the present invention is theprovision of a carpal implant having radial and ulnar flanges that areconfigured to abut portions of the carpal bone complex (whether resectedor not) in a way that supports the bones of the radial and ulnar sidesof the carpal bone complex. Accordingly, those skilled in the art willappreciate that the carpal implant of the present invention may beformed in any generally concave manner (i.e., wherein at least a portionof each of the radial and ulnar flanges is skewed to the axis of thebody) that is configured to abut the radial and ulnar sides of thecarpal bone complex (whether resected or not). Other examples of the“concave” formation of the carpal implant of the present invention areillustrated in FIGS. 10 through 12 and 15 through 27 and will bedescribed in detail below.

With renewed reference to FIGS. 2 and 3 and additional reference toFIGS. 5 and 6, the wrist bearing component 56 has the general shape ofan ellipsoidal segment and includes a generally flat abutting edge 120and a wrist bearing surface 122. As those skilled in the art willappreciate, the wrist bearing surface 122 does not extend to a pointwhere it intersects the abutting edge 120 as this would cause the wristbearing component 56 to be too large in size. Accordingly, the flatsides at which the wrist bearing surface 122 terminates permit the wristbearing surface 122 to be shaped in a desired manner while maintainingproper sizing of the wrist bearing component 56. A securing feature 124is formed into or otherwise coupled to the abutting edge 120 to permitthe wrist bearing component 56 to be secured to the proximal end of thecarpal implant 54. In the particular example provided, the securingfeature 124 is a blind tapered hole that is configured to matinglyengage the proximal stem 82. Those skilled in the art will readilyunderstand, however, that any appropriate coupling means may be employedto couple the wrist bearing component 56 to the carpal implant 54 and assuch, the scope of the present invention will not be so limited as torequire the coupling of the wrist bearing component 56 and the carpalimplant 54 through the engagement of a tapered stem with a tapered hole.As those skilled in the art will appreciate, the modular nature of thewrist bearing component 56 permits the surgeon to select from a varietyof wrist bearing components 56 that are differently sized and/or shapedto permit the surgeon to tailor the prosthetic wrist 50 to theindividual needs of the patient. Those skilled in the art will alsoappreciate that the surgeon's selection of a particular wrist bearingcomponent 56 may necessitate the use of a particular radial implant 52that has a correspondingly different size and/or configuration.

The wrist bearing component 56 is preferably formed from a cobalt 4chromium alloy, such as CoCrMo, which provides fatigue and corrosionresistance, as well as a relatively high degree of strength. Thoseskilled in the art will understand that other appropriate materials,including metals and/or plastics, may alternatively be employed to formthe wrist bearing component 56 or a portion thereof which includes thewrist bearing surface 122.

With particular reference to FIGS. 5 and 6, the wrist bearing surface122 is illustrated as being defined by a first radius 130 in the coronalplane and a second radius 132 in the sagittal plane. Preferably, thefirst and second radii 130 and 132 are different and more preferably,the first radius 130 is larger than the second radius 132. Configurationof the wrist bearing component 56 in this manner permits the prostheticwrist 50 to move in a manner that more closely approximates the motionof a natural wrist.

In situations where the wrist bearing surface 122 is contoured in amanner that is not defined by a single spherical radius, the orientationof the wrist bearing component 56 relative to the radial implant 52 iscritical. Accordingly, the prosthetic wrist 50 preferably also includesan alignment mechanism 150 in such situations for radially fixing thewrist bearing component 56 relative to the carpal implant 54 as isillustrated in FIG. 7. Preferably, the alignment mechanism 150 permitsthe surgeon implanting the prosthetic wrist 50 to orient the wristbearing surface 122 to a predetermined installation orientation that isdependent upon the orientation between the implanted carpal implant 54and the implanted radial implant 52. For example, if the radial implant52 were to be fixed to the distal portion 2 a of the radius 2 in amanner that was rotated slightly from that which was considered“nominal”, the surgeon may be able to compensate for the slight radialoffset by rotating the wrist bearing component 56 relative to the carpalimplant 54 in an equivalent manner.

The alignment mechanism 150 may permit the wrist bearing component 56 tobe rotated in an infinite number of positions relative to the carpalimplant 54, as would the connection of the wrist bearing component 56 tothe carpal implant 54 through the Morse taper connection of the proximalstem 82 and the blind tapered hole of the securing feature 124, orthrough adhesives, or recessed screws that extend through the wristbearing component 56 and which engage the body 70 of the carpal implant54 (not illustrated).

In the particular example provided, the alignment mechanism 150 permitsthe wrist bearing component 56 to be rotated into one of a plurality ofpredetermined orientations 152. In this regard, the alignment mechanism150 is illustrated to include a coupling member 154, which is coupled tothe carpal implant 54, and a plurality of holes 156 that are formed intothe wrist bearing component 56. Each of the holes 156 is sized toreceive the coupling member 154 and is defined by a centerline 158 thatis spaced circumferentially apart from the centerline 158 of an adjacenthole 156. Rotation of the wrist bearing component 56 relative to thecarpal implant 54 is accomplished via engagement of the coupling member154 into an associated one of the holes 156 that permits the wristbearing component 56 to be placed in the installation orientationrelative to the radial implant 52. Those skilled in the art willunderstand that the coupling member 154 may be removably coupled to thecarpal implant 54 so as to provide the surgeon with an option not to usethe coupling member 154 should the surgeon need more flexibility inpositioning the wrist bearing component 56 relative to the carpalimplant 54. Those skilled in the art will also understand that thecoupling member 154 and the holes 156 may be reversed (i.e., thecoupling member 154 may be attached to the wrist bearing component 56and the holes 156 may be formed in the carpal implant 54).

In another preferred form, the present invention provides a method forimplanting a prosthetic wrist 50 between the radius 2 and the portion 6a of the carpal bone complex 6 of a patient. The method includes:providing a carpal implant 54 including a body 70, a ulnar flange 72 anda radial flange 74, the body 70 having a stem 80 that is arranged alongan axis 86, the ulnar flange 72 being coupled to the body 70 andextending therefrom, the ulnar flange 72 having a lateral bone abutmentsurface 96, at least a portion of the lateral bone abutment surface 96being skewed to the axis 86 of the stem 80 by an angle of less than 90degrees, the radial flange 74 being coupled to the body and extendingtherefrom on a side opposite the ulnar flange 72, the radial flange 74having a medial bone abutment surface 110, each of the ulnar and radialflanges 72 and 74 having a bone screw aperture 98 a, 98 b, respectively,formed therethrough; resectioning the carpal bone complex 6 along linesthat are skewed to an axis of the capitate 20 and which correspond tothe distal faces of the ulnar and radial flanges 72 and 74 and theinterconnecting flange 84; forming an opening in the capitate 20 thatlies along an axis that is generally coincident with the axis of thecapitate 20; forming a pair of securing apertures 160 (FIG. 2) into thedistal portion 6 a of the carpal bone complex 6, one of the pair ofsecuring apertures 160 being formed in the hamate 22; securing thecarpal implant 54 to the distal portion 6 a of the carpal bone complex 6such that the stem 80 is at least partially disposed in the opening inthe capitate 20 and engaged to the capitate 20; providing a first andsecond screws 58, the first and second screws 58 being appropriatelysized to the pair of securing apertures 160 and the bone screw apertures98 a, 98 b; placing the first screw through the bone screw aperture 98 ain the ulnar flange 72 and the securing aperture 160 in the hamate 22and securing the first screw to the hamate 22 to bring the lateral boneabutment surface 96 into abutment with an ulnar side of a hamate 22; andplacing the second screw 58 through the bone screw aperture 98 b in theradial flange 74 and the other securing aperture 160 in the distalportion 6 a of the carpal bone complex 6 and securing the second screw58 to the distal portion 6 a of the carpal bone complex 6 to bring themedial bone abutment surface 110 into abutment with a radial side of thedistal portion 6 a of the carpal bone complex 6.

Preferably, the method also includes: providing a wrist bearingcomponent 56 having a wrist bearing surface 122 that is defined by afirst radius 130 in the coronal plane and a second, different radius 132in the sagittal plane; coupling the wrist bearing component 56 to aproximal stem 82 formed on the body 70 of the carpal implant 54 suchthat the wrist bearing component 56 is rotatable relative to the carpalimplant 54; and fixing the wrist bearing component 56 to the proximalstem 82 such that the wrist bearing component 56 is aligned at apredetermined installation orientation relative to the distal portion 6a of the carpal bone complex 6.

While the carpal implant 54 has been described thus far as beingunitarily formed and used in conjunction with a discrete wrist bearingcomponent 56, those skilled in the art will appreciate that theinvention, in its broader aspects, may be constructed somewhatdifferently. For example, the carpal implant 54 a may be configured toinclude a discrete flange structure 200 and a discrete stem 80 a asillustrated in FIG. 8. The flange structure 200 is unitarily formed froma suitable material, such as CoCrMo, and includes a bone abutmentsurface 202. In the particular example provided, the bone abutmentsurface 202 is shown to include an interconnecting, lateral and medialbone abutment surfaces 90 a, 96 a and 110 a, respectively, which mimicthe configurations of the interconnecting, lateral and medial boneabutment surfaces 90, 96, 110 (FIG. 3), respectively.

The stem 80 a is illustrated to include a tapered cylindrical portion206, which is configured to be fitted to a hole that is formed in thecapitate 20 (FIG. 2), and a connecting portion 210 for coupling the stem80 a to the flange structure 200. The tapered cylindrical portion 206 isgenerally similar to the stem 80 (FIG. 3) discussed above and includes aporous coating 212. The coating 212 or surface may also be plasmasprayed or roughened to form an uneven or unsmooth surface and need notbe porous.

In the example provided, the connecting portion 210 includes a threadedend portion 220, which is coupled to a proximal end of the taperedcylindrical portion 206, and a driving portion 224, which is coupled toan end of the tapered cylindrical portion 206 opposite the threaded endportion 220. The threaded end portion 220 is configured to extendthrough a stem receiving aperture 230 that is formed in the flangestructure 200 and threadably engage a threaded aperture 232 that isformed in the wrist bearing component 56 a. The driving portion 224 isillustrated to include a geometric feature, such as a male hexagon shank240, that permits the stem 80 a to be rotated with an appropriatelyconfigured tool 242 such that the threaded end portion 220 threadablyengages the threaded aperture 232 in the wrist bearing component 56 a.Those skilled in the art will readily understand that the drivingportion 224 may be of any shape (e.g., triangular, square, Torx®) andmay extend from the tapered cylindrical portion 206 in the form of ashank, or be recessed into the tapered cylindrical portion 206, in whichcase the tool 242 would have a corresponding male end to engage thedriving portion 224, rather than a corresponding female as illustratedin this example.

With the exception of the threaded aperture 232 and a pair ofanti-rotation tabs 246, the wrist bearing component 56 a is otherwiseidentical to the wrist bearing component 56 of FIG. 2. The anti-rotationtabs 246 are configured to abut a proximal side of the flange structure200 when the wrist bearing component 56 a is coupled to the carpalimplant 54 a to thereby inhibit relative rotation between the wristbearing component 56 a and the carpal implant 54 a. Those skilled in theart will appreciate, however, that other anti-rotation means mayadditionally or alternatively be incorporated into wrist bearingcomponent 56 a and/or the carpal implant 54 a, including matinggeometric features (e.g., a male hex protrusion formed onto the proximalside of the flange structure 200 and a mating hex recess formed into thedistal side of the wrist bearing component 56 a), fasteners and pins.The use of anti-rotation tabs 246 provides the wrist bearing component56 with a relatively greater range of motion as comparativelyillustrated by the angles α and β.

The modular configuration described above provides the surgeon with arelatively high degree of flexibility when differently sized componentsare available in a kit form as shown in FIG. 9. In the exampleillustrated, several wrist bearing components (i.e., wrist bearingcomponents 56 a and 56 a′), several flanges (i.e., flanges 200 and 200′)and several stems (i.e., stems 80 a and 80 a′) are provided in a kit250. The wrist bearing components 56 a and 56 a′ are configured with anidentical articular shape, but vary in their overall height dimension h.Similarly, the flanges 200 and 200′ and stems 80 a and 80 a′ aresimilarly configured, but vary proportionally to achieve a desiredoverall width, w, and/or length, l, for example.

In the embodiments of FIGS. 10 and 11, the carpal implants 54 b and 54 care generally similar to the carpal implant 54 (FIG. 3), except for theconfiguration of the interconnecting, ulnar and radial flanges. In FIG.10, the ulnar and radial flanges 72 b and 74 b, respectively, intersectone another and as such, this embodiment lacks the interconnectingflange 84 of the carpal implant 54. The ulnar flange 72 b is shown to beconfigured such that the lateral bone abutment surface 96 b is skewed tothe stem axis 86 by an angle of about 30 degrees, while the radialflange 74 b is shown to be configured such that the medial bone abutmentsurface 110 b is skewed to the stem axis 86 by an angle of about 45degrees. In FIG. 11, the interconnecting flange 84 c is configured suchthat the interconnecting bone abutment surface 90 c is accuratelyshaped. In the particular example provided, the interconnecting boneabutment surface 90 c is tangent to the lateral and medial bone abutmentsurfaces 96 c and 110 c, respectively.

A further embodiment is illustrated in FIG. 12, wherein the carpalimplant portion 54 d and the wrist bearing portion 56 d are unitarilyformed from a suitable material, such as CoCrMo. In the particularembodiment illustrated, the carpal implant portion 54 d is illustratedto include ulnar and radial flanges 72 d and 74 d, respectively, thatintersect one another in a manner that is similar to the ulnar andradial flanges 72 b and 74 b, respectively, of the carpal implant 54 bof FIG. 10. Those skilled in the art will appreciate, however, that theulnar and radial flanges 72 d and 74 d may be formed differently so asto intersect at any desired angle, or such that they are spaced apart byan interconnecting portion in a manner that is similar, for example, tothe configurations of the carpal implants 54 and 54 c of FIGS. 3 and 11,respectively.

A sixth embodiment is illustrated in FIGS. 13 and 14, and illustrates analternately constructed radial implant 52 e, wherein the bearing guide62 e is formed with an arcuate shape that is configured to matinglyengage the curvilinear cut 300 of a resected radius 2 a′. Those skilledin the art will appreciate that the curvilinear cut 300 will support thebearing guide 62 e and thereby permit the radial implant 52 e to beformed with a relatively lower profile as compared to the radial implant52.

A seventh embodiment is illustrated in FIG. 15, wherein the prostheticwrist 50 f is illustrated to be generally similar to the prostheticwrist illustrated in FIG. 8, except for the shape of the flangestructure 200 f and the wrist bearing component 56 f. More specifically,the flange structure 200 f includes a generally V-shaped interconnectingflange 84 f to which the ulnar and radial flanges 72 f and 74 f,respectively, are oppositely coupled. As will be apparent to thoseskilled in the art, the wrist bearing component 56 f is contoured tomatingly engage the proximal side of the flange structure 200 f andaccordingly includes a generally V-shaped profile 400. In a manner thatis similar to the prosthetic wrist of FIG. 8, the stem 80 f includes athreaded end portion 220 that is threadably received into a threadedaperture 232 that is formed in the wrist bearing component 56 f.

An eighth embodiment is illustrated in FIG. 16, which is similar to theprosthetic wrist of FIG. 8 except for the flange structure 200 g. Theflange structure 200 g of the prosthetic wrist 50 g includes aninterconnecting flange 84 g with an interconnecting bone abutmentsurface 90 g with a plurality of portions 500 that are each defined by askew angle. The skew angles that define each portion 500 need not besymmetrical about the stem axis 86 g. The skew angle of each portion 500is less than 90 degrees in magnitude to permit the interconnectingflange 84 g to conform and abut the proximal end of the distal portion 6a (FIG. 2) of the carpal bone complex 6 (FIG. 2).

A ninth embodiment is illustrated in FIGS. 17 and 18. The flangestructure 200 h is generally identical to the flange structure 200 g andas such, will not be discussed in further detail. The wrist bearingcomponent 56 h is generally similar to the wrist bearing component 56 a(FIG. 8) in that the ulnar (lateral) and radial (medial) portions of thedistal side of the wrist bearing component 56 h are angled to match theangled proximal surfaces of the ulnar and radial flanges 72 h and 74 h,respectively. However, the wrist bearing component 56 h also includesanterior and posterior located portions 600 on the distal sides of thewrist bearing component 56 h that extend distally in a manner thatoverlaps the flange structure 200 h. The configuration of the wristbearing component 56 h therefore inhibits both relative rotation andrelative anterior-posterior movement between the wrist bearing component56 h and the flange structure 200 h.

A tenth embodiment, which is also similar to the prosthetic wrist 50 g,is illustrated in FIGS. 19 and 20. In this embodiment, the flangestructure 200 i is similar to the flange structure 200 g except that theproximal side of the flange structure 200 i is parallel to the distalside of the flange structure 200 i (i.e., the proximal side of theflange structure 200 i includes a plurality of segments that areparallel to the segments that make up the distal side of the flangestructure 200 i). As will be apparent to those skilled in the art, thewrist bearing component 56 i is contoured to matingly engage theproximal side of the flange structure 200 i and accordingly includes aprofile 700 that matches the four angled surfaces that make up theproximal side of the flange structure 200 i.

An eleventh embodiment is illustrated in FIGS. 21 and 22, wherein theprosthetic wrist 50 j is illustrated to include a flange structure 200 jand a wrist bearing component 56 j. The flange structure 200 j isgenerally identical to the flange structure 200 i and as such, will notbe discussed in further detail. The wrist bearing component 56 j issimilar to the wrist bearing component 56 i in that it includes aprofile 700 j that matches the four angled surfaces that make up theproximal side of the flange structure 200 j. The wrist bearing component56 j also includes anterior and posterior located portions 600 j on thedistal sides of the wrist bearing component 56 j that extend distally ina manner that overlaps the flange structure 200 j. Moreover, the flange200 j, may be any appropriate geometry to substantially compliment ormatch the carpal plate.

According to various embodiments, illustrated in FIGS. 21A and 22A,wherein the prosthetic wrist 50 ja is illustrated to include a flangestructure 200 ja and a wrist bearing component 56 ja. The flangestructure 200 ja is generally similar to the flange structure 200 i andas such, will not be discussed in further detail. Nevertheless, it willbe understood that the prosthetic wrist 50 ja may include other featuresand variations. In addition, the flange 200 ja may include a proximalsurface 201 ja that is a substantially smooth arc or radius, asdiscussed here.

The wrist bearing component 56 ja is similar to the wrist bearingcomponent 56 i in that it includes a profile 700 ja that substantiallymatches or compliments the proximal side 201 ja of the flange structure200 ja. The proximal side 201 ja of the flange structure 200 ja includesa substantially smooth radius or arc. That is the proximal side 201 jamay be defined as an arc rather than a plurality of angles. The profile700 ja may include a substantially smooth radius or arc that complimentsor matches the arc of the flange 200 ja. Therefore, the flange 200 jaand the bearing component 56 ja may substantially mate when assembled.

The wrist bearing component 56 ja also includes anterior and posteriorlocated portions 600 ja on the distal sides of the wrist bearingcomponent 56 ja that extend distally in a manner that overlaps theflange structure 200 ja. Moreover, the flange 200 ja, including theproximal side 201 ja, may be any appropriate geometry to substantiallycompliment or match the surface 700 ja of the bearing 56 ja.

A twelfth embodiment is illustrated in FIG. 23 and includes a flangestructure 200 k and a wrist bearing component 56 k. The flange structure200 k includes a distal surface that is configured generally identicallyto the distal surface of the flange structure 200 g. The proximalsurface of the flange structure 200 k, however, is segregated into aplurality of zones 800 a, 800 b and 800 c. Zones 800 a and 800 c aregenerally parallel the ulnar and medial bone abutment surfaces 96 k and110 k. Zone 800 b, which is coupled at its opposite ends to zones 800 aand 800 c, is defined by a radius that tangentially intersects zones 800a and 800 c. The wrist bearing component 56 k includes a profile 700 kthat matches the proximal surface of the flange structure 200 k.

In FIGS. 24 and 25, a thirteenth embodiment is illustrated to include aflange structure 200 m and a wrist bearing component 56 m. The distalside of the flange structure 200 m is configured in a manner that isgenerally identical to the distal side of the flange structure 200 kdiscussed above. The proximal side 900 of the flange structure 200 m,however, is defined by a spherical radius 902. In the particularembodiment illustrated, the spherical radius 902 is centered at a pointthat is disposed along the axis 904 of the connecting portion 210 m.Those skilled in the art will appreciate, however, that the center ofthe spherical radius 902 may be positioned otherwise. The wrist bearingcomponent 56 m likewise includes a distal profile 700 m that matinglyengages the proximal side 900 of the flange structure 200 m.

In FIGS. 26 and 27, a fourteenth embodiment is illustrated to include aflange structure 200 n and a wrist bearing component 56 n. The flangestructure 200 n is generally similar to the flange structure 200 m,except that the proximal side 900 n is defined by a first radius 1002 inthe coronal plane and a second radius 1004 in the sagittal plane. Thewrist bearing component 56 n is likewise generally similar to the wristbearing component 56 m, except that the distal profile 700 n of thewrist bearing component is configured with a first radius in the coronalplane and a second radius in the sagittal plane so as to matingly engagethe proximal side 900 n of the flange structure 200 n.

While some embodiments have been illustrated to include a unitarilyformed component, such as a unitarily formed carpal implant, and othershave been illustrated to include a component assembly, such as a carpalimplant assembly that includes a discretely formed stem and a discretelyformed flange structure, those skilled in the art will appreciate thatany unitarily formed component may be formed in the alternativeutilizing a plurality of discretely formed components and that anyembodiment that is shown to be formed using a plurality of discretelyformed components may likewise be unitarily formed in the alternative.

With reference to FIG. 28, the carpal bone complex 6 includes a geometrythat also angles or curves about a radius between a volar side 1000 anda dorsal side 1002. The angle is between the volar side 1000 and thedorsal side 1002 of the carpal complex 6. Generally the bones includingthe hamate 22, the triquetrum 12, the lunate 10, the scaphoid 8, and thetrapezium 16 define the dorsal volar curvature or profile of the carpalcomplex 6. It may be selected to include the radius defined by thecarpal complex 6 in a carpal implant. The carpal implant that includesthe dorsal volar radius may allow for a substantially easierimplantation of the carpal implant and allow for a more naturalorientation of the bones of the carpal complex 6 after implantation ofthe carpal implant. It will be understood that although specificembodiments are illustrated for a carpal implant including the selectedradius, that any carpal implant may include the selected radius to allowfor a substantially natural implantation of the carpal implant relativeto the carpal complex 6.

With reference to FIG. 29, a carpal implant 1010 may be provided thatincludes a first segment 1012, a second segment 1014, and a thirdsegment 1016. Between the first segment 1012 and the second segment 1014may be a first angle 1018. Between the second segment 1014 and the thirdsegment 1016 may be a second angle 1020. The first angle 1018 and thesecond angle 1020 provide a radius about the volar side 1022 of thecarpal implant 1010 that includes a radius away from the dorsal side1024 of the carpal implant 1010. It will be understood that the geometryof the carpal implant 1010 may be included in any appropriate carpalimplant, such as various embodiments discussed above and herein.Nevertheless, it will be understood that the geometry of the carpalimplant 1010 is not limited to a particular embodiment but may beprovided in the various embodiments.

The carpal implant 1010 may include various bores such as a first screwbore 1026 and a second screw bore 1028. In addition, a third bore 1030may be provided for positioning the stem 80 (FIG. 3) that is to passthrough the carpal implant 1010. Regardless, it will be understood thatthe carpal implant 1010 may be provided with a plurality of portions orincluded with any of the implants as described above, or herein, so thatthe first angle 1018 and the second angle 1020 are operable to providethe substantially natural volar radius or dorsal bow for a prosthesis.

With regard to FIG. 29, a carpal implant 1040 may include a member 1042that extends between a first end 1044 and a second end 1046. The member1042 may define a radius 1048. The radius 1048 may provide that themember 1042 includes a substantially constant radius or arch between thefirst end 1044 and the second end 1046. The arch or angle between thefirst end 1044 and the second end 1046 may be substantially similar tothe arch or angle defined by the carpal implant 1010 except that theangle or arch of the carpal implant 1040 is substantially continuous.

The carpal implant 1040 may also include a plurality of portions. Forexample, the carpal implant may include a first screw bore 1050 and asecond screw bore 1052. In addition, the carpal implant 1040 may includea post bore 1054 that is operable to receive a post, as described above.

Although the carpal implant 1010 may include a plurality of angles 1018,1020, and the carpal implant 1040 may include a substantially continuousradius 1048, each may provide an angle or a bow that is substantiallysimilar to the carpal complex 6. Therefore, the carpal implant 1010,1040 may be implanted into an anatomy in a substantially natural manner.It will be understood, in addition, that the portions defining theselected bow or radius may be included in any appropriate carpalimplant. For example, the carpal implant 54 may include the selectedportions and angles that are substantially angled distally to allow fora formation about the carpal complex 6. The carpal implant 54 may alsoinclude the dorsal bow that may be defined by the angles 1018, 1020 orthe radius 1048. Therefore, it will be understood that the carpalimplant may include a plurality of features to allow it to be implantedinto a selected anatomy.

In addition, it will be understood that the carpal implant may besubstantially intraoperatively bowed to achieve a selected angle orradius. Therefore, during a procedure, a user, such as a surgeon, maydetermine that a selected bow or radius is required and forms theimplant to the selected radius. This may be done by cold working, hotworking, bending or any appropriate manner to form the selected bow orangles. Alternatively, or in addition, the carpal implant may besubstantially customized for a selected individual. Therefore, pre- orintraoperative measures may be taken of the patient's anatomy, includingthe dorsal or volar bow of the carpal complex 6 to allow for a formationof the selected carpal implant to substantially mimic that of thenatural anatomy of the patient. This may allow for a more naturalimplantation of the carpal implant into the anatomy of the patient for asubstantially more precise anatomical implantation.

With reference to FIG. 30, a carpal implant 1100 is provided. The carpalimplant 1100 may include a carpal complex engaging side 1102 and aproximal side 1104. The carpal implant 1100 may include the carpal side1102 that is generally similar to the above-described carpal implants.For example, the carpal engaging side 1102 may include a first or ulnarsection 1106, a second section 1108, a third section 1110 (wherein thesecond section 1108 and the third section 1110 may define a body), and afourth, ulnar, or augmented section 1112. The augmented section 1112 maydiffer from those described above and may be provided to replace aselected bone portion, such as the scaphoid 8 in the carpal complex 6.The augmented section 1112 may include an augmented or exterior surface1114 that may substantially replace the articulating surface of thescaphoid 8 during a procedure. Moreover, the augmented portion 1112 maybe substantially integral or modular. Therefore, the carpal implant 1100may include a member operable to receive a selected augmented region1112 for selection by a user.

The carpal implant 1100 may further include a screw fixation bore 1116and a post bore 1118. The screw which may be used to pass through thescrew bore 1116 and the post 80 (FIG. 3) may be similar to thosedescribed above. In addition a screw fixation bore 1117 may be formed inthe augmented section 1112. This may allow a fixation screw, such asthose discussed above, to be passed through the augmented section 1112to engage a portion of the carpal complex 6. This may allow fixing ofthe carpal implant 1100 to the carpal complex 6 in an appropriatemanner. In this way it may also be understood that the surface 1114 doesnot particularly articulate with a portion of the carpal complex 6 yetthe augmented section 1112 is operable to fill a void in the carpalcomplex 6, such as due to the removal of a selected bone from the carpalcomplex 6. Nevertheless, the augmented section 1112 may be provided toreplace a selected boney portion and the remaining boney portions of thecarpal complex 6 may articulate therewith, as discussed herein. Althoughit will be understood that the carpal implant 1110 may be connected tothe carpal complex 6 in any appropriate manner, as mentioned above suchthat that surface 1114 does not articulate with the carpal complex 6.

The proximal surface 1104 of the carpal implant 1100 may include asubstantially continuous convex radius such that it may articulate witha radial implant or a portion of the radius. Alternatively, the carpalimplant 1100 may be fixed to a bearing member, such as the bearingmember 56, to articulate with the radial implant. The carpal implant1110 may allow for articulation of various portions of the carpalcomplex 6 with the other portions of the complex 6 and the radius 2 toallow for substantial replacement of the natural articulation of thewrist.

With reference to FIG. 31, the carpal implant 1100 may be positioned inthe carpal complex 6 such that the augmented region 1112 replaces thescaphoid bone 8. Therefore, the augmented region 1112 may be able toarticulate with the trapezium bone 16 and the trapezoid bone 18. Theaugment region may also articulate with the capitate bone 20 as will beunderstood by one skilled in the art. Therefore, a screw, such as thescrew 58, may be used to engage the hamate bone 22 and the carpalimplant 1110 is allowed to articulate freely with the other boneyportions of the complex 6. Nevertheless, the augmented region 1112 neednot articulate with the carpal complex 6.

The resection of the carpal complex 6 may be similar to a resectionotherwise required to implant a carpal implant except that the scaphoid8 may be replaced with the augmented region 1112. The articulatingsurface 1114 may be defined in such a way that the augmented region 1112is operable to articulate with the selected bony portions tosubstantially mimic the natural articulation in the wrist. This may beselected if the scaphoid bone 8 is substantially removed due to aresection procedure, an injury, or the like. Therefore, it is notnecessary to fix the carpal implant 1110 to a bone portion through theaugmented region 1112, but the other bone portions of the carpal complex6 may simply articulate with the augment region 1112. It will beunderstood, however, that the carpal implant 1110 can be fixed to anyselected portion of the carpal complex 6.

It will be understood that the carpal implant 1110 may include anyappropriate augments to engage any selected portions of the carpalcomplex 6. Therefore, the augmented region 1112 may be provided toreplace the scaphoid bone 8 or other articulating the selected portionsof the scaphoid complex 6. Thus, any appropriate augmented region of thecarpal implant 1110 may be provided.

In addition, other various embodiments may include various portions thatprovide for replacement of selected bone segments such as the augmentedregion 1112. Thus, the carpal implant 1110, according to variousembodiments or in conjunction with various embodiments, may be providedto replace a selected or bony portion to allow for a substantiallynatural articulation within the carpal complex regardless of thecondition of the carpal complex. The augmented region 1112 may also beprovided to replace other boney portions, such as the lunate 10.Moreover, the carpal implant 1110, as mentioned above, may besubstantially modular such that the augmented region 1112 may or may notbe included. Moreover, the augmented region may be selected to replace aselected bone by selecting a particular module.

In addition, the post 86 may be provided in the carpal implant 1100 toengage the bone portion capitate bone 20 and also engage the selectedbearing member 56. Nevertheless, as discussed above, the radius side1104 of the carpal implant 1100 may substantially provide anarticulating or bearing surface to articulate or bear with the radius 2or the radial implant 52, or any appropriate radial implant.Nevertheless, the carpal implant 1110 may articulate both with theradial portion, such as the radius 2, the radial implant 52, or anyappropriate radial implant, and may also articulate with selectedportions of the carpal complex 6. Therefore, the carpal implant 1100 mayinclude both the radial side articulating surface 1104 and thearticulating surface 1114 substantially defined by the augmented region1112. Regardless, the carpal implant 1100 may be provided to allow forreplacement of selected bony portions, such as those bony portions thatare substantially incapable of providing anatomical support orarticulation, by use of the augmented region 1112. Again, such asdiscussed above, the region 1112 need not articulate with the carpalcomplex 6 but may fill a mass in the carpal complex 6.

With reference to FIG. 32, a distal radial implant 1200 is illustratedaccording to various embodiments. The distal radial implant 1200 may beprovided as a substantially modular implant that includes a stem portion1202 that is operable to be positioned relative to a selected portion ofthe radius 2, such as intramedullary. Affixed or interconnected with aselected portion of the stem portion 1202 is a distal radial segment1204. The distal radial segment 1204 may be provided to engage the stem1202 to provide a selected orientation, configuration, size and otherconsiderations for the distal radial implant 1200. Furthermore, a distalradial bearing 1206 may be provided that may engage a selected portionof the distal radial segment 1204. As discussed herein, the bearing 1206may be fixed to the distal radial segment 1204, may articulate with thedistal radial segment 1204, or may be provided in any appropriateconfiguration. In addition, the bearing 1206 may be omitted, as abearing extending from the carpal implant may articulate with the distalradial segment 1204. Alternatively, the bearing member 1206 may beomitted, as a carpal implant or portions of the carpal complex 6 mayarticulate directly with the distal radial portion 1204. Nevertheless,the modular distal radial implant 1202 may be provided in a mannerallowing a user, such as a physician, to select a distal radial implantintraoperatively to substantially match the anatomy of a patient.

With reference to FIG. 33, the stem 1202 includes a body portion 1208and a neck or engaging portion 1210. The neck portion 1210 may include aconnection area, such as a male connection post, to engage a respectivefemale connecting area, discussed herein, in the distal radial segment1204. For example, the stem connection 1210 may include a groove ordetent 1212 that is operable to engage a deflectable member or portionof the distal radial segment 1204. Nevertheless, the connection member1210 may be provided to allow for an interconnection of the stem 1202with the distal radial component 1204.

The body portion 1208 of the stem 1202 may include a selected geometry.For example, the body portion 1208 may be substantially cylindrical ortapered/conical to allow for easy insertion of the stem 1202 into theradius 2. The body 1208, however, may include a selected geometry tosubstantially resist rotation of the distal radial implant 1200 afterimplantation. For example, various extensions or keys, such as fins ortabs 1214, may be provided that extend from an exterior of the body 1208such that the fins 1214 may engage a selected portion of the bone. Inaddition, the body 1208 may include a selected irregular geometry orregular geometry that includes portions that may resist rotation. Forexample, the body 1208 may include a substantially square or rectangularcross-section, may define a substantially “I-beam” cross-section, anoval cross-section, a star cross-section, a cruciform cross-section, orany appropriate cross-section. Nevertheless, the body portion 1208 maybe provided for allowing both substantially easy implantation of themodular distal radial implant 1200 and a mechanism to resist rotation ofthe distal radial implant 1200 after implantation thereof.

Furthermore, the stem 1202 may be provided in a plurality of dimensions,such as a diameter, length, curve radius, cross-section, andcombinations thereof. For example, the stem portion 1202 may include adiameter or a cross-sectional size 1216, a length 1218, or any otherselected dimensions that may be varied. Therefore, a kit 1600 (FIG. 44),or other appropriate selection may be provided such that one or more ofthe stems 1202 may be provided with one or more variations in theselected dimensions 1216, 1218. For example, in the kit 1600, aplurality of the stems 1202 may be provided where each of the stems 1202include a slightly different length 1218 such as about 4 cm, about 6 cm,and about 8 cm. Therefore, during a procedure, such as an implantationof the distal radial implant 1200, a user, such as a physician, mayselect the appropriate length for the stem 1202.

With reference to FIGS. 34A and 34B, the distal radial segment 1204,according to various embodiments, is illustrated as the distal radialsegment 1204 a. The distal radial segment 1204 a may include portionsthat are operable to engage the stem 1202. Nevertheless, the distalradial portion 1204 a may be formed according to various embodiments,including various embodiments exemplary illustrated herein, orcombinations thereof.

The distal radial component 1204 a generally includes a body portion1230 and a superior or articulating portion 1232. The body portion maybe formed in any appropriate manner to engage a selected portion of theanatomy. The body 1230 may include selected dimensions such as a length1234, a width 1236, a height 1238, and an arch or radius 1240. Thevarious dimensions 1234, 1236, 1238, and 1240 may be varied for variousapplications. As discussed above, and in conjunction with the stem 1202,a plurality of the distal radial segments 1204 a each including a uniqueset of dimensions 1234-1240 may be provided. Each may be provided in alarge inventory or in the kit 1600 (FIG. 44) for selection by a usersubstantially intraoperatively or preoperatively. Nevertheless, varioussizes or configurations of the distal radial implants 1204 a may beprovided to allow for a substantially customized fit with a selectedpatient.

The distal radial component may also include the articulating region orportion 1232 that may also include a plurality of selected dimensions.For example, the articulating region 1232 may include a length 1242 anda width 1244. The articulating region 1232 may also include anarticulation depth 1246 that may vary depending upon a selectedapplication. The articulation depth 1246 may generally be understood tobe the deepest portion of the concave region 1248 that defines thearticulating surface of the articulating region 1232. The uppermostportion of the height 1246 may be a point where the articulating surfacestops or transforms into a lip 1252. Therefore, the upper portion 1250of the articulating surface may extend to the edge of the articulatingregion 1232 or may stop intermediate thereof. Again the articulatingregion 1232 including the various dimensions 1242-1246 may be varied andunique for a plurality of the implants 1204 a. Therefore, again, theuser may select the distal radial implant 1204 a according to selectedrequirements or dimensions of a patient.

The distal radial implant 1204 a may define a selected geometry of thebody 1230. For example, the body may include a single or plurality ofdepressions 1254 for various reasons. For example, the depressions 1254may assist in allowing for a fixation of the distal radial implant 1204a to a selected portion of the anatomy. In addition, the body 1230 maybe substantially smooth over the surface thereof or include othervarious selected geometries. Again a plurality of geometries may beselected for various uses during an implantation.

The articulating region 1232 may include the first lip 1252 and a secondlip 1256. The lips 1252, 1256 may extend a distance beyond an edge ofthe body 1230. The lips 1252, 1256 may be dimensioned depending upon aselected portion of the anatomy or a selected patient.

Defined in the body 1230 is a female receiving or interconnectionportion or depression 1260. The female interconnection 1260 may includea dimension that allows for substantial interconnection with the maleinterconnection 1210 of the stem 1202. The reception or interconnectionportion 1260 may include a deformable member (such as a canted coilspring or screw or other mechanism) 1262, or screw which may engage thedepression 1212 of the stem 1202. Therefore, the distal radial component1204 a may be interconnected with the stem 1202 for an implantation. Itwill be understood, that the body 1230 may define a male connection andthe stem define a female connection. Thus the interconnection may beperformed in any appropriate manner and these are merely exemplary.

With reference to FIGS. 35A and 35B, a distal radial implant 1204according to various embodiments of a distal radial implant 1204 b isillustrated. The distal radial implant 1204 b includes portions similarto the distal radial implant 1204 a and like numerals will be used toindicate like portions. The distal radial implant 1204 b includes a bodyportion 1270 and an articulation portion 1272. The body 1270 may besubstantially similar to the body 1230 of the distal radial implant 1204a. Nevertheless, the articulation region 1272 may include a projectionor flat spot 1274. The flat spot 1274 may be viewed as a portion of thebody 1270 but extends a distance substantially parallel to a base 1276of the body 1270. The flat portion 1274 may substantially abut a distalportion of the radius 2 during and after implantation. Therefore, theflat portion 1274 may allow for a substantially stable interconnectionwith the radius 2 after the implantation. Alternatively, the flatportion 1274 may be provided for a further connection or fixationportion to engage the radius 2.

Nevertheless, the distal radial implant 1204 b may include the pluralityof dimensions 1234, 1236, 1238, 1240, 1242, 1244, and 1246. As discussedabove, the plurality of dimensions may be substantially unique anddifferent among a plurality of the distal radial implants 1204 b for amodular interconnection and selection by a user. In addition, the flatportion 1274 may be provided on the distal radial implant 1204 b as oneof a plurality of the distal radial implants 1204 that may be providedin an inventory or the kit 1600 for use by a user. Therefore, the distalradial implant 1204 b may be provided for forming a distal radialimplant 1200 depending upon a selected patient.

With reference to FIGS. 36A and 36B, a distal radial implant 1204according to various embodiments of a distal radial implant 1204 c isillustrated. The distal radial implant 1204 c may include portions thatare similar to the portions of the distal radial implant 1204 a and likenumerals are used to reference like portions of the distal radialimplant 1204 c. In addition, it will be understood that the distalradial implant 1204 c may include portions that are selectable to beused with other various embodiments of the distal radial implant 1204 aand the distal radial implant 1204 c is merely exemplary.

The distal radial segment 1204 c includes a body 1280 that may besimilar to the body 1230 of the distal radial implant 1204 a. Therefore,the body 1280 may also include the female engaging portion 1260 operableto engage a selected portion of the stem 1202. Nevertheless, asdiscussed above, the female engaging portion 1260 may be any appropriatesize, configuration and the like. In addition, any appropriate portionmay be provided to engage the stem 1202. In addition, the body 1280 mayinclude selected portions, such as depressions, dimensions and the likethat may be substantially different for a selected use or patient.

Extending distally from the body 1280 is the carpal engaging region orportion 1282. The carpal engaging region 1282 can extend from the body1280 to engage a selected portion of the carpal complex 6. The bones ofthe carpal complex 6 may be held within the carpal engaging portion 1282so that the bones of the carpal complex 6 are operable to articulate ina generally natural manner but may be held relative to one another toallow for a fixation of the wrist relative to the distal portion of theradius. Essentially the holding portion 1282 may surround a selectednumber or volume of the carpal complex 6 to allow for retention of thenatural boney portion after implantation of the distal radial segment1204 c.

The distal radial segment 1204 c may be provided for a substantiallyhemi-arthroplasty where substantially only the distal portion of theradius 2 is replaced. The distal radial segment 1204 c may articulatewith the carpal complex 6 to reduce the need for a carpal implant.Further, distal radial segment 1204 c can include an ulna articulationportion 1452, as discussed further herein. This articulation section canallow for a selected articulation of the ulna 4 with the distal radialsegment 1204 c.

With reference to FIG. 37, the distal radial implant segment 1204 c maybe implanted to substantially capture or surround selected portions ofthe carpal complex 6 such as the scaphoid 8, the lunate 10, thetriquetrum 12, and the trapezium 14. Therefore, if any portions of thesebones are resected or if the portions of the carpal complex 6 are leftsubstantially whole, they may be enclosed within the carpal complexportion 1282 of the distal radial implant 1204 c It will be understoodthat the containing portion 1282 may be shaped and sized for anyappropriate application and may include a selected geometry for holdingor fixing a selected number of the bones of the carpal complex 6.Moreover, a bearing component may be fit or molded onto the containerportion 1282 to allow for a substantially smooth articulation of thevarious bones of the carpal complex 6 relative to the distal radialimplant segment 1204 c. The ulna 4 can be positioned relative to theimplant member 1282 at any appropriate position and me be near thesurface or deeper based upon various characteristics.

Returning reference to FIGS. 36A and 36B, the distal radial implantsegment 1204 c includes the carpal engaging section 1282 which mayinclude a plurality of selected dimensions. For example, the carpalcontaining section 1282 may include a selected high or ulnar side 1284and a radial side 1286. This may allow for the carpal engaging section1282 to substantially mimic the natural shape of the distal radialportion and how it would engage the carpal complex 6. For example, thedistal radial implant 1204 c may engage and hold the carpal complex bone6 in a selected orientation and shape. Therefore, the high side 1284 mayinclude high side height 1288 and a low side 1286 may include a low sideheight 1290. Furthermore, the carpal containing section 1282 may includea length 1292 and a width 1294. Therefore, the carpal containing section1282 may include a plurality of dimensions 1288-1294 that may beselected and varied depending upon a particular patient or user. Inaddition, as discussed above, a plurality of the radial distal implants1204 c may be provided in either an inventory or kit 1600 for selectionduring a procedure to allow for a substantial customization of theimplant for a selected patient.

Nevertheless, the carpal containing selection 1282 may allow for holdinga selected number of the carpal bones in the carpal complex 6 in aselected manner for a substantially natural articulation. The carpalcontaining section 1282 may hold portions of the carpal complex 6 in amanner such as to allow for an articulation of even a weakened orfractured carpal complex. In addition, the carpal containing section1282 may be used when various portions of the anatomy may be resected,such as removal of the entire proximal row of the carpal complex 6. Inaddition, the carpal containing section 1282 may retain resectedportions of the bone segments that form the proximal row of the carpalcomplex 6 and may allow for collecting the portions of the carpalcomplex in such a manner to allow for articulation of the carpal complex6 relative to the radius 2 by way of the distal radius segment 1204 c.

With reference to FIGS. 38A and 38B, a distal radial implant 1204according to a various embodiment of a distal radial implant 1204 d isillustrated. The distal radial implant 1204 d may include portionssimilar to the distal radial implant 1204 a and like numerals are usedto indicate like portions.

The distal radial implant 1204 d may be similar to the distal radialimplant 1204 c in that both may be used for a substantiallyhemi-arthroplasty of the wrist including a resurfacing or arthroplastyof substantially only the radius bone 2 or the distal radial portion.Therefore, the distal radial segment 1204 d may include a body 1290 thatincludes the female engaging portion 1260. The distal radial implantsegment 1204 d may interconnect with the stem 1202 to allow forformation of a selected distal radial implant. In addition, the bodyportion 1290 may include selected detents and other formations to allowfor an implantation of the distal radial implant 1204 d into a selectedanatomy.

Extending from the body portion 1290 is an articulating or carpalportion 1292. The carpal portion 1292 may include a ulnar or first side1294 and a radial or second side 1296. Extending between the two sides1294, 1296 is a surface, such as an articulation surface 1298. Thearticulation surface 1298 may be a substantially metal articulationsurface that does not necessarily require a bearing, such as a polymerbearing. The articulating surface 1298 may be used to articulate with aselected portion of the carpal complex in a substantially hemiarthroplasty replacement. Therefore, the articulating surface 1298 maybe substantially a metal, or any other appropriate material, including aplastic, ceramic, pyrocarbon (also referred to as pyrolytic carbon)portion such that the body 1290 and the articulating region 1292 may beformed as a substantially single portion.

The articulating region 1292 may be provided in such a manner toarticulate with a selected portion of the carpal complex 6 in a way thatallows for replacement of only the distal portion of the radius 2without augmentation of the carpal complex 6. Therefore, particularly inselected situations such as a fracture, chip and the like of the radius2, the distal radial implant 1204 d may be used to resurface theselected portion of the radius 2 without requiring a carpal implant.

The articulating region 1292 may include selected dimensions such as aheight 1300, a length 1302, and a width 1304 that may be different orselected depending upon a use or patient. For example, a selected sizeof the carpal complex 6 may require a selected size of the articulatingregion 1298 to engage the carpal complex 6 in a selected manner. In thisway, the articulating portion 1298 may articulate with the carpalcomplex 6 to allow for replacement of substantially only the distalportion of the radius 2 rather than a replacement of a portion of thecarpal complex 6 and a carpal implant.

Although the articulating region 1298 may be a substantially metal orhard material, such as a ceramic or pyrocarbon, articulating region, itwill be understood that the articulating region 1298 may also include abearing. The bearing may include a polymer bearing, such as a bearingformed of a ultra-high molecular weight polyethylene or any otherappropriate bearing portion. Alternatively, the bearing surface 1298 maysimply be a highly polished surface which allows for substantially easy,smooth articulation of portions of the carpal complex 6 relative to thedistal radial implant segment 1204 d. It will be understood, therefore,that the various distal radial implants 1204 may be used for a completeor hemi arthroplasty of the radius 2.

With reference to FIGS. 39A and 39B, a bearing component 1206 accordingto selected embodiments of a bearing component 1206 a is illustrated.The bearing 1206 a may be interconnected with a selected distal radialimplant 1204 according to various embodiments. Therefore, it will beunderstood that the bearing portion 1206 a may be affixed to a selectedone of the distal radial implants such as the distal radial implant 1204a.

The bearing components 1206 a includes an articulation or carpal bearingside 1310 that defines a bearing surface 1312. The bearing component1206 a also defines a distal radial bearing side 1314. The distal radialbearing side 1314 defines a distal radial bearing surface 1316. Thedistal radial bearing surface 1316 is provided to substantially seatwithin the bearing side 1232 of the distal radial implant 1204.

The bearing 1206 a may be substantially fixed to the distal radialcomponent 1204 a in any appropriate manner. For example, the bearing1206 a may be adhesively affixed, mechanical affixed, welded, otherwisebonded, or the like. For example, a selected deformable or engagable lipor edge 1318 may be provided to engage the lip 1252 and, 1256 of thedistal radial implant 1204 a. Alternatively, various locking portionssuch as screws, bars, and the like may substantially interconnect thebearing components 1206 a with the distal radial components 1204 a.Therefore, the bearing components 1206 a may substantially be heldrelative to the distal radial component 1204 a allowing for asubstantially stable base of articulation of the carpal complex 6 andportions of the wrist relative to the varying portion 1206 a and thedistal radial implant 1204 a.

The articulating surface 1312 of the distal radial implant 1206 a mayallow for articulation of selected portions of the distal carpal complex6. The carpal complex 6 may be allowed to articulate within thearticulating surface 1312 to allow for a natural articulation of thewrist relative to the implant 1200.

Alternatively, the articulating surface 1312 may be provided toarticulate with a selected portion of the carpal implant according tovarious embodiments. For example, the carpal bearing member 56 may beprovided to articulate within the articulating surface 1312 of thebearing member 1206 a. Therefore, a total wrist replacement may beprovided that includes the carpal implant 54 and the carpal bearingimplant 56. The carpal bearing implant 56 may include a substantiallypolymer or a substantially metallic surface. Nevertheless, it isgenerally selected to provide a metal on polymer bearing articulationsuch that the bearing member 1206 a may be formed of either a polymer ora metal portion.

Alternatively, a carpal implant such as the carpal implant 1100 may beprovided. The articulating surface 1104 of the carpal implant 1100 maybe allowed to articulate with the articulating surface 1312 of thebearing member 1206 a. Therefore, the carpal implant 1100 may beimplanted relative to the carpal complex 6 and may then articulate withthe bearing 1206 a. Therefore, no additional or separate bearingcomponents may be necessary and the bearing 1206 a may divide thebearing portion between the carpal implant 1100 and a selected distalradial implant segment 1204.

As discussed above, the distal radial bearing 1206 a may besubstantially molded to the distal radial implant segment 1204 to allowfor a fixation of the bearing components relative to the distal radialsegment 1204. Thus, the modular component may be provided to allow for aminimal amount of portions that are necessary to be implanted to form asubstantially total wrist arthroplasty.

With reference to FIGS. 40A and 40B, a distal radial bearing member 1206b which is a distal bearing member according to various embodiments ofthe distal radial bearing member 1206 is illustrated. The distal radialbearing member 1206 b may be provided with any of the selected distalradial implant segments 1204. According to various embodiments, thedistal radial implant 1206 b may be interconnected with the distalradial implant 1204 b.

For example, the distal bearing implants 1206 b may be substantiallymolded or adhered to the distal radial implant 1204 b similar to thefixation of the distal radial bearing portion 1206 a. Therefore, variousfixation mechanisms such as an adhesive, a screw, a locking bar and thelike may be provided. For example, a substantial locking tab orprojection 1350 may be provided to engage a rim or section 1272 of thedistal radial implant 1204 b. The distal radial bearing member 1206 balso includes an articulation side 1352 that defines a bearing surface1354. The bearing surface 1354 may articulate with a selected portion ofthe carpal complex 6 or a selected portion of a carpal implant.

As discussed above, the articulation surface 1354 may articulate with abearing portion of a carpal implant 54 or any appropriate bearingportion of a selected various embodiment of a carpal implant. Inaddition, the articulation surface 1354 may articulate with anarticulating surface 1104 of the carpal implant 1100, discussed above.Therefore, either the carpal implant 1100 alone may articulate with thebearing member 1206 b or a separate bearing portion, which isinterconnected with a carpal implant, may articulate with the bearingsurface 1354 of the bearing implant 1206 b.

In addition, the bearing portion 1206 b includes a flat or flatextending portion 1356 that extends proximally away from thearticulating side 1352. The flat portion 1356 may extend around the flatportion 1274 of the distal radial implant 1204 b. This may allow forproviding a portion of the bearing member around a selected portion ofthe distal radial implant 1204 b for selected purposes. The extending orflat member 1356 may define a void 1358 which is operable to engage orreceive a selected portion of the flat portion 1274 of the distal radialimplant 1204 b.

The bearing portion 1206 according to various embodiments, including theexemplary embodiments, 1206 a and 1206 b, may include variousdimensions, such as height 1360, a length, 1362 and a width 1364 or aplurality of dimensions. Therefore, the bearing component 1206 accordingto various embodiments may include a substantial plurality number ofunique and selectable dimensions for various applications. Therefore, auser may select one of a plurality of the varying components 1206 tomeet selected requirements of a particular patient. The user may selectan implant from the kit 1600 (FIG. 44), an inventory or the like toprovide an implant for the requirements of a selected patient.

Therefore, it will be understood that the modular distal radial implant1200 may include a plurality of the stems 1202, a plurality of thedistal radial segments 1204, and a plurality of the distal radialbearing components that may be selected and interconnected in variousand selected manners. This allows for the distal radial implant 1200 tobe provided as a substantially selectable implant for various particularpatients and uses by a user, such as physician. The modular assembly mayalso allow for a substantial intraoperative selection of the implant fora particular patient by a physician or user. Thus, the implantation mayproceed while allowing for a substantially intraoperative customizationof the implant 1200 to the patient. In addition, the modular implant1200 may be easily augmented or portions replaced during a revisionprocedure due to the modular nature of the implant 1200.

As briefly discussed above, it will be understood that various implantsmay be provided as substantially hemi-arthroplasty or total wristreplacement. For example, the carpal implants, such as the carpalimplants 54 or the carpal implant 1100 may be provided to interconnectwith selected portions of the carpal complex 6 to substantiallyarticulate with a natural portion of the radius and ulna, as illustratedin FIG. 45. Therefore, a hemi-arthroplasty of the wrist joint or thewrist area may be provided by only resurfacing or providing the carpalimplant. As discussed above, the carpal implant may include a size tointerconnect with a plurality of the bones of the carpal complex 6 ormay also replace a selected portion of the bones of the carpal complex6. Regardless, the carpal implant may be provided to articulate with anatural portion of the radius.

Likewise, the distal radial implant according to various embodiments maybe provided to substantially articulate with a natural portion of thecarpal complex, as discussed above and herein. Therefore, the distalradial implant may be provided to articulate with a selected carpalimplant or articulate with selected portions of the carpal complex 6.

As discussed above, the various portions of the distal radial implantmay include a substantially modular distal radial implant 1200. Thedistal radial implant 1200 may include a plurality of distal radialportions 1204 which may include a plurality of the distal radial implantsegments 1206 from which may be chosen one to articulate with a naturalportion of the carpal complex 6, a carpal implant, or a combinationthereof. Therefore, in the kit 1600 or a supply, the selected implantmay be chosen to include the distal radial implant portion 1200 that isoperable to interconnect or articulate with a natural portion of thecarpal complex 6 or the carpal prosthesis. It will be understood thatthis may be done substantially intraoperatively such that a user, suchas a physician, is able to choose from the kit 1600 or selecting theportions that are required intraoperatively to allow for a substantialcustomization regarding the selected patient.

With reference to FIG. 41, a distal radial implant 1400 according tovarious embodiments is illustrated. The distal radial implant 1400generally includes a stem 1402 and a distal radial segment 1404. It willbe understood that the distal radial segment 1404 may be substantiallymodular from the stem 1402, such as the modular radial implant 1200.Therefore, the stem 1402 may be substantially similar to the stem 1202and the distal radial portion 1404 similar to the distal radial portion1204. Thus, the distal radial portion 1404 may be provided in the kit1600 or supplied to be interconnected with a selected one of the stems1202 for formation of the distal radial implant 1400. Regardless, itwill be understood that the distal radial implant 1400 may besubstantially provided as a single member for implantation and may alsobe included in the kit 1600 of modular portions.

The distal radial segment 1404 generally includes a body portion 1406that is interconnected with the stem 1402. As discussed above, the bodyportion 1406 and the stem 1402 may be substantially formed as a singlemember such that the distal radial portion 1404 is not substantiallyseparable from the stem 1402. Such a configuration may be selected forvarious reasons, such as strength, materials, and the like. Regardless,the distal radial portion 1404 may define an articulation regionextending distally from the body 1406.

The articulating side 1408 may include a first articulating fossa orsurface 1410 and a second articulating fossa or surface 1412. The firstarticulating surface 1410 may substantially replicate a scaphoid fossafor articulation with a scaphoid bone 8 after implantation. The secondarticulation surface 1412 may be designed to substantially articulatewith the lunate bone 10 after implantation. Therefore, the articulatingsurface 1408 of the distal radial segment 1404 may be designed tosubstantially replicate the natural articulating surfaces of the radius2. This may allow for a substantially natural articulation of the carpalcomplex 6 relative to the radius 2 after a hemi-arthroplasty regarding aresurfacing or replacement of the distal portion of the radius 2.

The articulating surface 1408 may include a bearing portion that issubstantially fixed to the body 1406. Alternatively, the articulatingsurface 1408 may include the substantially identical material to thebody 1406. For example, the body 1406 may be formed of a selected metalor metal alloy and the articulating surface 1408 may be provided as asubstantially polished surface to allow for a selected articulation ofthe scaphoid 8 and the lunate 10 relative to the distal radial segment1404.

The articulating surface 1408 may be defined substantially flat orstraight across the articulating surface 1408. Although the articulatingsurface 1408 may include the depressions 1410 and 1412 to define thearticulating surfaces, the articulating region 1408 may be substantiallystraight across its upper surface to as not to substantially hindermovement of the carpal complex. Therefore, the distal radial segment1404 may include a height 1414, a selected length 1416, and a width1418.

As discussed above, it will be understood that the various dimensions1414-1418 may be substantially unique among a plurality of the distalradial segments 1404 for selection by a user substantiallyintraoperatively or preoperatively. Regardless, this allows the user tosubstantially select the portion for the distal radial implant 1400, ora modular portion for the distal radial implant 1200 to substantiallysuit a selected patient. Therefore, the user may be able to selectwhether to provide a hemi-arthroplasty or complete wrist replacementduring the operative procedure depending upon the state of the patient.

With reference to FIG. 42, a distal radial implant 1450 according tovarious embodiments is illustrated. The distal radial implant 1450 mayinclude portions that are substantially similar to the distal radialimplant 1400 and similar reference numerals are used to reference likeportions. Therefore, the distal radial implant 1450 may include the stem1402 and a distal radial segment 1404.

As discussed above, the stem 1402 may be substantially modular relativeto the distal radial segment 1404 to provide for a modular implantationof the distal radial implant 1450. In addition, a plurality of the stems1402 and the distal radial segments 1404 may be provided for selectionby a user. Alternatively, a plurality of a fully integrated distalradial implant 1450 may be provided. Therefore, the stem 1402 may besubstantially integral with the distal radial segment 1404 or may beprovided separately therefrom for interconnection during an operativeprocedure.

The articulating region 1408 of the distal radial implant 1450 mayinclude the first articulating portion 1410 and the second articulatingportion 1412. The first articulating portion 1410 may be provided toarticulate with the scaphoid 8. As discussed above, the secondarticulating portion 1412 may be provided to articulate with the lunatebone 10.

Depending upon a selected patient's anatomy, the ulnar side of thedistal radial segment 1404 may also include a recess 1452 forarticulation with the ulna 4. As will be understood by one skilled inthe art, the radius 2 may articulate with the ulna 4 during ananatomical motion (such as pronation or supination) of the wrist or armportion and this may become damaged. Therefore, during an operativeprocedure which may be required or replacement or a resurfacing of thedistal radial portion, the preparation of the radius 2, such as aresection thereof, may require removing the articulating region of theradius 2 that would generally articulate with the ulna 4. Therefore,using the distal radial implant 1450, including the recess 1452, maysubstantially allow an articulation of the ulna with the implant 1450connected to the radius 2, after implantation of the distal radialimplant 1450, in a substantially natural manner. It will be understoodthat the recess 1452 may be provided with any selected embodiment or invarious embodiments of the distal radial implant and the distal radialimplant 1450 is merely exemplary. For example, the recess 1452 can beadded to the distal radial segment 1204 c (FIGS. 36A and 36B).

In addition, the distal radial implant 1450 may include a curve orcurvilinear portion 1454 that may be provided to substantially engage orhold a selected portion of the carpal complex 6 in a selected location.The carpal complex 6, such as after a trauma, may be unstable andrequire additional stabilization or retainment in a selected anatomicalorientation. Therefore, the curvilinear portion 1454 may be provided onthe distal radial implant 1450 for holding the selected portion of thecarpal complex 6 in a location. It will be understood, again, that thecurvilinear portion 1454 may be provided on any selected implant forholding the carpal complex 6 in a selected location.

Therefore, it will be understood that the illustrated embodiments aremerely exemplary and not intended to limit the scope of any exemplaryembodiments. Regardless, providing an articulating surfaces 1410 and1412 that allows for substantially natural articulation of the carpalcomplex 6 relative to the distal radial implant 1400, 1450 may beselected to include further restricting portions such as the curvilinearportion 1454. Similarly, a resection of the radius 2 may allow or beselected to use the recess 1452 to create an articulation region for theulna.

With reference to FIG. 43, the distal radial implant 1450 is illustratedexemplary implanted into a selected anatomy. The stem 1402 is implantedinto the radius 2 to provide a fixation of the distal radial implant1450 relative to the radius 2. The distal radial segment 1404 ispositioned at an end, such as the distal end of the radius 2 afterpreparing the radius 2 for the implantation. The curvilinear portion1454 is provided to retain a selected portion of the anatomy, such asthe scaphoid 8 relative to the distal radial implant 1450. The firstfossa 1410 is positioned to articulate with the scaphoid 8 while thesecond fossa 1412 is positioned to articulate with the lunate 10. Inaddition, the depression 1452 is provided to allow an articulation ofthe distal portion of the ulna 4 with the distal radial implant 1450.

Therefore, the implantation of the distal radial implant of 1450 mayprovide for articulation relative to the substantial natural oranatomical carpal complex 6 rather than positioning a carpal implantrelative to the carpal complex 6. It will be understood that the distalradial segment 1404 may also include a bearing portion such as a polymerportion that may articulate with the bony portions such as the scaphoid8 and the lunate 10. Regardless, as discussed above, the articulatingsurfaces 1410, 1412 may be substantially polished metal portions toallow for a smooth articulation of the natural portions of the carpalcomplex 6.

Therefore, it will be understood that each of the exemplary embodimentsmay include portions that are substantially dissimilar from the selectedexemplary embodiments and may include combinations of each of thevarious embodiments. Therefore, the exemplary embodiments are notintended to limit the scope of the following claims but merely areprovided to exemplify the portions thereof. Therefore, with reference toFIG. 44, the kit 1600 or supply may include a plurality of the stemportion 1202 a, 1202 b that each include a selected unique dimension,such as a length 1208 a, 1208 b, respectively. Furthermore, the kit 1600may provide a plurality of distal radial portions 1204 a, 1204 b, 1204 cto provide a distal radial portion according to any of the variousembodiments. Also, the kit 1600 may provide a plurality of distal radialbearing members 1206 a, 1206 b that are operable to provide any of thevarious embodiments discussed above. The kit may be used by a userduring procedure to select and assemble a distal radial implant that issubstantial customized to a selected patient.

Furthermore, the kit 1600 may provide a plurality of the carpalimplants, such as the carpal implant 54 according to variousembodiments, or the carpal implant 1100 and the bearing 56 according tovarious embodiments for selection by a user. In this way, a user mayselect to provide a hemi-arthroplasty to provide a prosthesis relativeto the carpal complex 6 alone or relative to the radius 2 alone.Alternatively, the user may select to provide a substantially totalwrist replacement that will provide a distal radial implant and a carpalimplant. While selecting either of the total wrist arthroplasty or thehemi-arthroplasty, the user may also select various portions that may beprovided to allow for a customized implant relative to the patient. Theselection may occur substantially intraoperative due to the kit whichincludes a plurality of members which may be assembled to form theselected prosthesis.

As discussed above, various implant portions, such as the distal radialimplant 1415, can be used to articulate with a selected natural portionof the carpal complex 6. For example, if a fracture or other injury, dueto an action or disease, of the distal radius, the distal radius can bereplaced relative to the carpal complex 6. Although the carpal complex 6may be substantially unharmed due to an injury or disease, the distalradius may necessitate replacement or a natural articulation may beimproved by replacement of the distal radius portion. Therefore, thedistal radius portion can be replaced with a selected implant, includingthose discussed above, and those described herein. As discussed above,the distal radial implant can be provided in the kit 1600 to include aplurality of portions, such as the stem portion 1202 and a plurality ofthe distal radial portions 1206. Therefore, a selected user, such as aphysician, can select an implant combination that is suitable orappropriate for a selected patient. The selection can be based upon theamount of resection required, the condition of the bone, or otherappropriate considerations.

As discussed herein, various implant portions and selections can be usedto achieve a selected result for a procedure. Although any appropriateprocedure can be used, exemplary methods are described herein to achievea selected result for a selected ailment. For example, a distal radialimplant can be used to replace a fractured distal radius portion. Asdiscussed above, the implants can include both a carpal replacement anda distal radial replacement. Nevertheless, it may be selected, that onlya distal portion of the radius need be replaced or is appropriatelyreplaced. Therefore, the distal radius can include a portion that canarticulate with the natural carpal complex in a substantially anatomicalor natural manner or with a carpal implant.

With reference to FIG. 46, a distal radial implant 1470 according tovarious embodiments is illustrated. The distal radial implant 1470 caninclude the stem portion 1202 or any appropriate stem. The stem portion1202 can be formed in any appropriate manner and in any appropriatelength. As discussed above, the stem portion 1202, can be provided in aplurality of sizes such as widths, lengths, geometries and the like forselected implantations. Nevertheless, the stem portion 1202 can beprovided in a kit, such as that described herein or above, that includessubstantially single shape, size, geometry or the like and can beinterconnected with a plurality of other modular sections.

The distal radial implants 1470 can include a distal radial portion ormember 1472. The distal radial portion 1472 can include a first section1474 that includes a region to interconnect with the stem portion 1202.The interconnection portion 1476 can include any appropriate connectionportion such as a taper, a thread, a locking portion, or the like. Forexample, as described above, the stem portion 1202 can include a threadregion 1212 that can interconnect with an internal thread in theconnection region 1476.

The distal radial portion 1472 can further include a carpal engagingarea 1478. The carpal engaging area 1478 can include an articulationsurface or articulation region 1480. The articulation surface 1480 canbe formed in any appropriate manner to articulate the selected portionof the carpal complex 6 or carpal implant.

The articulation surface 1480 can include a lowermost region 1480′ thatextends a distance 1482 above a surface 1483 defined by the carpalengaging region 1478. The distance 1482 can be formed at any appropriatedimension for various purposes, such as substantially or selectivelymatching a selected anatomy. Generally, the distance 1482 can be about0.25 mm to about 2.0 mm, or any appropriate dimension. Nevertheless, itwill be understood that the distal radial portion 1472 can be providedin a plurality of sizes, including a plurality of the dimensions 1482for selection from a kit by a user, as discussed herein.

Further, the distal radial portion 1472 can be formed of any appropriatematerial. For example, the entire distal radial portion 1472 can beformed of a polymer material, such as a high density polyethylene, ametal, a metal alloy, or a combination thereof. Also, the stem engagingportion 1474 can be formed of a metal or metal alloy while the carpalengaging portion 1478 can be formed of a polymer material. The polymermaterial can interconnect with the metal material in any appropriatemanner, such as with a locking tab, be molded onto the stem engagingportion 1474, or any appropriate attachment. Nevertheless, it will beunderstood that the distal radial portion 1472 can be formed of anyappropriate material or combinations of materials for selected purposes.

With additional reference to FIG. 47, the carpal engaging section 1478defines the articulating surface 1480 that can articulate with aselected portion, such as the carpal complex 6. It will be understoodthat the carpal articulating section 1478 can also articulate with aselected implant, such as a carpal implant, including those describedabove or any appropriate carpal implant. The articulating portion of thecarpal implant can articulate with the carpal articulation surface 1480in a selected manner. Alternatively, the distal radial portion 1472 canbe replaced in a revision or selected procedure to implant a distalradial portion that is appropriately suited to articulate with aselected carpal implant.

In addition to the carpal articulation surface 1480, an ulnaarticulation surface or recess 1484 can also be provided. The ulnaarticulation recess 1484 is operable to articulate with a selectedportion of the ulna 4 after implantation of the distal radial member1472. This can allow for a generally natural articulation of the ulna 4after implantation of the distal radial portion 1472. The ulnaarticulation recess 1484 can be formed in any appropriate manner toappropriately articulate with the ulna 4.

A first wall or portion 1486 and a second wall or portion 1488 can boundthe carpal articulation surface 1480. This can help hold the variousportions of the carpal complex 6 in a selected manner after positioningthe distal radial member 1472. Therefore, the carpal complex 6 can bemaintained substantially intact and can be held to allow for asubstantially anatomical or natural articulation with the distal radialmember 1472.

In addition to various embodiments, including those various embodimentsdescribed above, a distal radial implant can be provided with aplurality of modular portions. With reference to FIGS. 48 and 49, adistal radial implant 1500 is illustrated. The distal radial implant1500 can include various portions such as a stem 1502. The stem 1502 canbe similar to the stem 1202, described above. Regardless, the stem 1502can generally be positioned in a portion of the bone, such as anintramedullary canal of the radius 2 to hold the distal radial implant1500 in a selected position. The distal radial implant 1500 can furtherinclude a bone replacement portion 1504. The bone replacement portion1504 can be provided for various selected anatomies and procedures, suchas those described herein.

The bone replacement portion 1504 can include a selected dimension, suchas a height 1506. The height 1506 can be provided in a plurality ofdifferent heights, such as height 1506 a, 1506 b, 1506 c, 1506 d, 1506 eand 1506 f, illustrated in phantom. It will be understood, asillustrated in the kit 1590 (FIG. 50) that the bone replacement portion1504 can be provided in a plurality of sizes including at least one ofthe heights 1506-1506 f. Therefore, it will be understood that theheight 1506-1506 f is a height that can be selected by a user, such as aphysician, to replace a selected amount of bone that may be damaged,resected, removed, or the like. The bone replacement portion 1504 canalso include a dimension such as a width 1508. The bone replacementportion 1504 can further include a plurality of widths 1508.

The distal radial implant 1500 can further include an articulating orcarpal articulating section or portion 1510. The articulation portion1510 can include a high walled or high side 1512 that includes aselected height 1514, and can also be included in a plurality of theheights 1514. Further, the carpal articulating portion 1510 can furtherinclude a low side 1516 that can include a second height 1518. Similarto the first height 1514, the second height 1518 can be provided in aplurality of dimensions along with a plurality of the carpal engaging acarpal articulating section 1510.

With continuing reference to FIGS. 47 and 48, the various modularportions of the distal radial implant 1500 can be provided according toselected embodiments. For example, the stem 1502 can include an engagingsection 1520 that can engage an engaging portion 1522 in the bonereplacement section 1504. The engaging section 1520 can include externalthreads while the bone replacement portion 1504 can include internalthreads in the engaging portion 1522. This can allow the stem 1502 to beinserted into the IM canal of the radius 2 and the bone replacementportion 1504 to be threaded onto the stem 1502. Alternatively, or inaddition thereto, a screw or bolt can be passed through the bonereplacing portion 1504 to engage the stem 1502. Further, various otherlocking portions, such as a locking ring, or any other appropriatemechanism can be provided to interconnect the bone replacing portion1504 with the stem 1502.

Further, the stem 1502 can include any appropriate geometry, extensions,shaped, or the like to engage the radius 2. For example, the stem 1502can include an I-beam or other appropriate geometry to allow forfixation or rotation resistance after implantation of the stem 1502 intothe bone, such as the radius 2. Further, various fins similar to thefins 1204 on the stem 1202, can be provided. Regardless, the stem 1502can be interconnected with the radius 2 in a selected manner to allowfor positioning of the distal radius implant 1500 Also, the stem 1502and the bone replacement portion 1504 can be interconnected prior toimplantation.

The stem 1502 can include a plurality of mechanisms to interconnect withthe bone replacement portion 1504 as discussed above. Nevertheless, thebone replacement portion 1504 can include any appropriate geometry toreplace a selected portion of the anatomy, such as a distal portion ofthe radius 2. Although the distal portion of the radius 2 may beresected for any appropriate reason such as injury, disease, and thelike, the geometry of the bone replacement portion 1504 can be formed asa modular member or be custom formed for a selected individual basedupon various considerations. Nevertheless, the bone replacement portion1504 can include a stem connecting portion 1522 which can be anyappropriate portion. Also a keel 1523 can extend from the bonereplacement portion 1504 to engage bone to assist in maintaining aposition of the portion 1504, such as to resist rotation.

Further, the bone replacement portion 1504 can include a plurality ofthe heights 1506 and the widths 1508. It will be understood that thedifference between the various heights 1506 can be any appropriateincrement, such as 1 mm, 2 mm, 3 mm, 4 mm, any fraction thereof, or anymultiple thereof. Thus the bone replacing portion 1504 can be providedas a plurality of components in the kit 1590 or a kit according to anyvarious embodiments for selection by a user. It will be understood,however, that the bone replacing portion can be provided in anyappropriate manner. For example, the bone replacing portion 1504 can betelescopic. The telescopic bone replacing portion 1504 can include asingle member than can be adjusted to various heights, such as selectedby a user. The telescopic bone replacement portion may be infinitelyadjustable or may include a plurality of discrete adjustments.Regardless, it will be understood that the bone replacement portion 1504may be provided as one or a plurality of members and can be provided inthe kit 1590.

Further, the bone replacing portion 1504 can be formed of anyappropriate material such as a polymer, a metal, a metal alloy, aceramic, or any combination thereof. For example, the bone replacingportion 1504 can be formed of a metal that can interconnect through thestem 1502 and may also be formed of a metal or metal alloy. Thus theconnection between the stem 1502 and the bone replacing portion 1504 canbe substantially strong and stable over a long period of time.

Further, the bone replacing portion 1504 can include a top portion orarticulating connecting portion 1530. The articulating connectingportion 1530 can include a projection 1532 that extends above a ledge ordepression 1534. This can allow the articulating portion 1510 tosurround or encase a portion of the bone replacement member 1504 and toreceive it within a depression area 1536. This can allow for asubstantially strong interconnection between the articulating portion1510 and the bone replacing portion 1504. Nevertheless, it will beunderstood that the articulating portion 1510 need not completelysurround any portion of the bone replacing portion 1504 and the bonereplacement portion 1504 may alternatively include a portion thatsurrounds a portion of the articulating member 1510. Therefore, it willbe understood that any appropriate interconnection can be formed betweenthe bone replacement portion 1504 and the articulating member 1510.

Further, a bore 1538 can be formed through the articulating connectionregion 1530 that is operable to receive a locking member, such as a bolt1540. The bolt 1540 can include a threaded end 1542 and a driving end1544. The threaded end 1542 can engage a threaded portion of the bore1538 or a threaded portion of the articulating region 1546. Thearticulating region 1510 can also include a bore portion 1548 throughwhich the bolt 1540 can pass. This can allow the bolt 1540 toselectively interconnect to the articulating member 1510 with the bonereplacement member 1504. The bolt 1540 can pass through each of thebores 1548, 1538 and engage the threaded region 1546 to securelyinterconnect to the articulating member 1510 with the bone replacementmember 1504. It will be understood, nevertheless, that the articulatingmember 1510 can interconnect with the bone replacement member 1504 inany appropriate manner. In other words, the bolt 1540 is not necessaryand any other appropriate connection can be used, such as a taper, alocking ring, an adhesive, or any other selected connection.

The articulating member 1510 includes the various articulating surfaces.The articulating member 1510 can include a carpal articulation surface1550. The carpal articulation surface 1550 can articulate with anyappropriate portion, such as a carpal implant, a portion of the carpalcomplex, or any of the selected bones of the carpal complex 6.Therefore, the carpal articulation surface 1550 can be provided tointeract with any of the appropriate portions or the articulating member1510 can be specialized for articulation with the selected portion. Thearticulating surface 1550 can be formed at any appropriate distanceabove a bottom 1552 of the articulating member 1510. The distance 1554can be any appropriate distance and can differ among the various membersof the articulating member 1510. For example, the kit 1590 can include aplurality of the articulating member 1510 that can be used in the distalradial implant 1500. Therefore, a user can achieve a selected result byforming or selecting one of the articulation members 1510 that include aselected articulation surface 1550 for implantation.

In addition to the carpal articulating surface 1550, the articulatingmember 1510 can also include an ulna articulating surface 1560. The ulnaarticulating surface 1560 can allow for an interconnection orarticulation of the ulna with the articulating member 1510. Therefore,the distal radial implant 1500 can replace substantially all of thearticulations of the distal portion of the radius 2 for variouspurposes. Therefore a user can resect the distal portion of the radius 2and replace it with the distal radius implant 1500 and substantiallyachieve a selected anatomical or natural articulation.

The various portions of the distal radial implant 1500 can be formed asa single piece member so that the stem 1502, the bone replacement member1504, and the articulating member 1510 are not separate modular members.Although, each of these various portions can be formed as a singlemember they can also be formed as a plurality of portions that can beinterconnected. Further, each of the portions can be formed as a singlepiece with one or more of the other portions. Therefore, each of thestem 1502, the bone replacing member 1504, or the articulating member1510 can be provided as modular portions that can be interconnected withany of the other portions in a slightly less modular system or in asingle piece system for a selected implantation. Thus, one skilled inthe art will understand that the system can be more modular or lessmodular based on various considerations and manufacturing techniques orpurposes.

For example, a single piece member, illustrated in FIG. 50 can beprovided. A single piece implant 1700 can to include portions that aresubstantially similar to that of the implant 1500, but they can beformed as a single piece or unit. For example, the single piece implant1700 can include a stem portion 1702, a bone replacement portion 1704,an articulation portion 1706, and an ulnar articulation portion 1708.Each of these portions can be similar to portions found in the implant1500 save that they are formed as a single member or unit. It will beunderstood, however, that various portions may still be modular in theimplant 1700. For example, an articulating portion can interconnect withthe articulating portion 1706, such as a bearing surface or bearingmember. Therefore the single piece implant 1700 can be formed of aselected material, such as a metal, and a polymer articulating portioncan interconnect with the articulating portion 1706.

Though the bone replacement portion 1704 can be formed as one piece itcan also be formed in a plurality of sizes or dimensions, such asheight, 1710. For example, the single piece implant 1700 can be providedas a plurality of members (1700 a, 1700 b, 1700 c) in the kit 1590 thateach include a different height 1710. The height 1710 can vary betweenthe various implant by any appropriate amount such as 1 mm, 2 mm, 3 mm,4 mm, or any appropriate fraction or multiple thereof. Thus, it isunderstood that the single piece implant 1700 can be provided inaddition to, or alternatively to, the modular implant 1500. Further, theheight 1710 can be varied in any appropriate manner such as providing aplurality of the single piece implant 1700 providing a telescopic bonereplacement portion 1704, or members that may interact over the stem1702.

For example, the height 1710 can be altered by providing a modularmember 1718 that includes a central bore 1720 that includes a geometrythat would allow it to interact with the stem portion 1702. Therefore,the augmenting member 1718 can be fit over the stem portion 1702 toengage the bone replacement portion 1704. This would augment the height1710 of the bone replacement portion 1704 by the height of theaugmenting member 1718. The stem 1702, however, can still allow forconnection of the single piece implant 1700 to the bone portion, such asthe radius 2. The augmenting portion 1718 can be connected to the singlepiece implant 1700 or be held in place by fixation of the implant 1700to the anatomy. Regardless, the implant 1700 can be provided as asubstantially complete implant or be augmented by other portions, suchas the augment portion 1718.

Various portions, such as the articulating member 1510 can also beformed of more than one material. For example, the articulating member1510 can include a base 1570 that is formed of a first material and anarticulating area 1572 formed of a second material. The base 1570 can beformed of a strong or hard material such as a metal or metal alloy thatcan substantially interconnect with the bone replacing portion 1504. Thearticulating surface or upper portion 1572, however, can be formed of aportion that can articulate with a bone member in a substantially longlasting or natural manner. Therefore, the upper portion 1572 can beformed of any appropriate material, such as a polymer including a highdensity polyethylene, a selected metal or metal alloy, a pyrolyticcarbon, a ceramic, or any appropriate material. Therefore, variousportions of the implant 1500, such as the articulating member 1510, canbe formed of a plurality of materials to achieve a selected result.Further, the articulating member 1510 can be formed of various materialsdepending upon whether it articulates with a natural bone, such as abone with a carpal complex 6, or with a member that can replace aselected portion of the carpal complex 6.

Further, the articulating member 1510 can be provided in the kit 1590according to various embodiments that can be selected based upon anobserved condition. For example, during a surgical planning, it may bedetermined that a live view by a user, such as a physician, is necessaryto determine whether any of the carpal bones need to be replaced.Therefore, a kit 1590 can include both an articulating member 1510, thatis able to articulate with a natural bone and one that is able toarticulate with an implant for the carpal complex 6.

In addition to the distal radial implant 1500 a carpal implant can beprovided to articulate directly with a portion of the radius 2, withreference to FIG. 20. As will be understood by on skilled in the art ahemi-arthroplasty of the wrist can also include replacement ofsubstantially only the carpal bones 6. Thus the carpal implant 50,according to various embodiments can be implanted into the carpalcomplex to articulate with a natural portion of the radius 2. Further,as discussed herein the kit 1590 can also include the carpal implant 50.Thus, a user can determine intraoperatively whether a hemi-arthroplastycan be performed, on either of the radius or the carpal complex 6.

Further, as discussed herein, the modular distal radial implant 1500 canbe assembled to articulate with the natural carpal complex 6 or with thecarpal implant 50. Also, as discussed herein, the articulating member1510 can be changed during a revision procedure to articulate with acarpal implant implanted during a revision procedure. Thus, it will beunderstood, that a hemiarthroplasty or total arthroplasty of the wristcan be performed. If a hemiarthroplasty is selected it may be of eitherthe distal radius or the carpal complex 6.

The kit 1590, with reference to FIG. 51, can include the distal radialimplant 1500, or any distal radial implant according to variousembodiments. The distal radial implant 1500 can be provided in modularpieces, such as those discussed above, or as a single piece member. Forexample, however, the articulating member 1510 can be provided invarious sizes and configurations, such as 1510 a, 1510 b, and 1510 c.The various sizes can be selected by a user, such as a physician, basedupon an observed requirement or position. The various sizes of theimplant members can be provided in the kit 1590 and the user can selectthem either pre-operatively or intra-operatively. Therefore, the variousportions of the kit 1590 can be provided whether or not the user haspre-operatively determined a selected size or determinesintra-operatively the configuration for a selected patient.

Further, the kit 1590 can include a plurality of the bone replacementportions 1504, such as the portions 1504 a, 1504 b, and 1504 c. Each ofthe various bone replacement portions 1504 can include a differentheight 1506, such as those discussed above. It will be understood thatany appropriate number of the bone replacement portions 1504 can beprovided, such as 10 bone replacement portions 1504 each including adifferent height 1506 that differs by about 1 mm. Nevertheless, it maybe selected to provide less or more of the bone replacement member 1504based upon a selected procedure or use. As mentioned above, however, asingle bone replacement member 1504 can be provided that includes atelescopic portion.

Further, the kit 1590 can include the stem 1502 in a plurality of sizesor configurations such as the stem 1502 a, the stem 1502 b, or the stem1502 c. Again, the different sizes or configurations of the stems 1502can be provided for selection by a user either pre-operatively orintra-operatively. Nevertheless, the plurality of the sizes,configurations, or the like can be used by a user to achieve an optimalor a selected result.

The kit 1590 can further include the connecting member 1540 such as thebolt. It will be understood that various other connecting members may beprovided if selected. For example a snap ring, a cotter pin, or otherdevices can be provided.

The kit 1590 can also include, or alternatively include, the implant1700. The implant 1700 can be included in a plurality of sizes 1700 a,1700 b, and 1700 c, Each of these sizes can vary by any appropriateamount, as discussed above. Also, it will be understood, that the kit1590 can include only the implant 1700 and not the implant 1500, orboth.

The kit 1590 can further include a carpal implant or replacementportion. The carpal implant can be provided according to variousembodiments or provided according to a plurality of embodiments.Further, the carpal implant can be provided in a plurality of sizes. Thecarpal implant can include a flange of various sizes 200′, 200″, 200′″.The carpal implant can be provided in the kit 1590 to include the stem87′, 80″, 80′″, in various sizes. Also the wrist bearing component 56′,56″, 56′″ can be provided in the kit 1590 in various sizes. It will beunderstood that any appropriate number of sizes of the variouscomponents can be provided in the kit 1590, and three sizes is merelyexemplary.

Therefore, the user can obtain the kit 1590 and intra-operativelydetermine an appropriate or more optimal configuration. Thus, not onlycan the user determine whether a hemi-arthroplasty of either the carpalbones or the radius is selected or whether a hemi- or total arthroplastyis required to replace both the distal radius and the carpal bones.Further, the user can determine and select the amount of radialresection and the user may select a size of the bone replacement memberto achieve a result. The user may also determine an appropriate size orconfiguration of the stem 1502, the articulating member 1510 and otherappropriate considerations. It will be understood, however that the kit1590 can include more modular components or instruments. For example,various adhesives, impacters, drill motors, reamers, saws, or the likecan be used or provided in the kit 1590 for use by a user. Nevertheless,the various modular components are illustrated in the kit 1590 merelyfor purposes of the present discussion.

It will be understood that the implant members, such as the distalradial implant 1500, can be used according to any appropriate method,such as for a hemi-arthroplasty, a total arthroplasty, or any selectedprocedure. Nevertheless, the distal radial implant 1500 can be usedaccording to the method described herein and illustrated in FIGS. 52-55.It will be understood that the following method described andillustrated is merely exemplary and not intended to limit theapplication or scope of the present teachings.

With initial reference to FIG. 52, the radius 2 may include a fracture1600. The fracture 1600 can be formed according to any appropriatereason, such as an injury, a disease, or the like. Nevertheless, thefracture 1600 can be formed in a radius 2, such as in a distal region ofthe radius 2 that may be replaced with a distal radial implant, such asthe distal radial implant 1500. The fracture 1600 may be determinedaccording to any appropriate procedure, such as an x-ray, a magneticresonance imaging scan, a computer tomography scan, or the like.Nevertheless, once the fracture 1600 is discovered, a user, such as aphysician, may determine whether the fracture 1600 can heal undernatural or anatomical conditions or whether a portion of the radius 2may be replaced with a distal radial implant. It will be understood thatthe fracture 1600 in the radius can be unique and none of the carpalbones in the carpal complex 6 may be compromised or fractured or variousbones in the carpal complex 6 may also be injured.

To achieve a resection of the radius 2, an incision 1602 can be formedthrough various soft tissues 1604 of a patient. The soft tissue 1604 caninclude skin, dermis, muscle, tendons, ligaments, adipose tissue, andother soft tissue portions. Nevertheless, the incision 1602 can provideaccess to the radius 2 near the region of the fracture 1600. After theincision 1602 has been formed, it can be augmented with variousinstruments, such as a retractor 1606. The incision 1602 can thereforebe made into any appropriate dimension, but can initially be formed inan appropriate dimension to achieve access to the radius 2 for resectinga portion of the radius 2 and implanting a selected prosthesis. Forexample, the incision 1602 can include a dimension, such as a length ofthe incision that is about 1 cm to about 15 cm. This can achieve areduced invasive procedure for either a hemi- or a total arthroplasty ofany portion of the wrist. After the incision 1602 is formed, anyappropriate resecting instrument, such as a saw 1608, that isinterconnected with an appropriate motor 1610 can be used to resect aselected portion of the radius 2. For example, the radius 2 can beresected near the incision 1600 or proximal to the fracture 1602.

With reference to FIG. 53, the radius 2 can be resected any appropriateamount, such as at a distance of 1612. The distance 1612 can be anyappropriate amount and may depend upon the position of the fracture1600, the strength of the bone surrounding the fracture 1600, or anyother appropriate consideration. Nevertheless, the distance of theresection 1612 can be used to assist in selecting an appropriate sizefor the bone replacement member 1504. Also, the user, such as aphysician, can monitor or observe the anatomy of the patient todetermine whether or what size of the bone replacement portion isappropriate for a selected patient regardless of the amount of boneresected. The resection distance 1612 can be similar or related to thedimension, such as the height 1506 of the bone replacement member 1504.

With reference to FIG. 54, the radius 2 is initially resected at anappropriate location to allow repair of the fracture 1602. It will beunderstood that once the radius 2 has been resected a selected amount,that various preparatory steps can be performed to allow forimplantation of the distal radial implant 1500. For example, the IMcanal of the radius 2 can be reamed with any appropriate tool to allowfor application of the stem 1502 into the radius 2. Further, a reamingor resection of a portion of the radius 2 can be performed to allow forpositioning of the keel 1523 of the bone replacement portion 1504. Asdiscussed above, the keel 1523 can interconnect with a selected portionof the radius 2 to resist rotation of the bone replacement portion 1504after implantation thereof. Therefore, it will be understood that theradius 2 or any other appropriate bone portions, such as bones of thecarpal complex 6 or the ulna 4 can be prepared for implantation of thedistal radial implant 1500 or any appropriate distal radial implantaccording to various embodiments. Further, it will be understood thatthe radius 2 or any other bone portions need not be prepared forimplantation of the various portions of the distal radial implant 1500,but rather the various portions of the distal implant 1500 can beinterconnected with the radius 2 and implanted therein, such as withimpaction.

The stem 1502, with reference to FIG. 54, can be positioned in the IMcanal of the radius 2. The stem 1502 can be positioned in the IM canalin any appropriate manner. For example, the IM canal can be reamed toprepare an opening for positioning the stem 1502 therein and forpositioning various other materials, such as antibiotics, adhesives,bone cements or the like. Alternatively, or in addition thereto, thestem 1502 can be driven or impacted into the IM canal of the radius 2without any prior preparation. Regardless, the stem 1502 can bepositioned relative to the radius 2 to allow for interconnection of thevarious other portions of the distal radial implant 1500.

The bone replacement portion 1504 can be selected based upon the anatomyof the patient. The bone replacement portion 1504 can be connected tothe stem 1502 either before or after the stem is positioned in theradius 2. As discussed above, the amount of resection 1612 can be usedto select the bone replacement portion 1504. For example, it may beselected that the entire amount of resection 1612 can be replaced withthe bone replacement portion 1504. The articulating portion 1510 wouldthen only replace the articulating surface or geometry of the radius 2.Alternatively, the bone replacement portion 1504 may only replace aportion of the bone resected 1612 and the articulating member 1510 canalso replace a portion of the resected bone and the articulatingsurfaces. Nevertheless, the various sizes provided in the kit 1590 canbe used by a user, such as a physician, to achieve the selected resultwith the patient.

Also, the various members or trialing components can be used to trialvarious sizes to achieve an optimum or selected configuration for thedistal radius replacement 1500. The trialing components, though notspecifically illustrated, can be substantially similar to the componentsof the distal radial implant 1500. The trialing components can simply betemporarily interconnected to allow trialing of the articulation of thecarpal complex 6 relative to the radius 2 and the ulna 4 to achieve aselected anatomical or natural articulation.

The bone replacement portion 1504 can be selected from a plurality ofsizes provided in the kit 1590, as described above. Once the selectedbone replacement portion 1504 is selected from the kit 1590, it can beinterconnected with the connecting portion 1520 of the stem 1502. Asdiscussed above, the keel portion 1523 can be positioned in a reamed outarea in the radius 2 or simply impacted into the radius 2.Alternatively, or in addition thereto, the keel 1523 may not be providedand the bone replacement portion 1504 contacts a resected surface of theradius 2. Regardless, various other components, such as antibiotics,other medications, cements, or the like, can be provided to interconnectthe bone replacement portion 1504 with the radius 2 and the stem 1502.It will be understood that the various components can be sized andorientated to be passed through the incision 1602 formed in the softtissue 1604.

With reference to FIG. 55, the articulating member 1510 can bepositioned relative to the bone replacement portion 1504. As discussedabove, the articulating member 1510 can be provided in a plurality ofheights 1514, 1518 and a user, for implantation relative to the radius2, can select an appropriate height. The articulating member 1510further includes an articulating surface 1550 that can articulate withvarious portions of the carpal complex 6. It can be further understoodthat the depth or height of the articulating surface 1550 can also varyand be selected. Therefore, again, the user can select an appropriatearticulating member 1510 that can include any appropriate orientation ofthe articulating surface 1550.

Further, the articulating member 1510 includes the ulna articulatingsurface 1560 with which the ulna 4 can articulate. Therefore, theappropriate dimensions of the articulating member 1510 can also includedetermining the appropriate location of the articulating surface 1560for the ulna.

Nevertheless, the user, such as the physician, can select an appropriatearticulating member 1510 from the kit 1590. Further, it will beunderstood that the trialing portion for the articulating member 1510,though not specifically illustrated, can be provided for trialing todetermine an appropriate dimension, geometry, and like of thearticulating member 1510.

Once the appropriate articulating member 1510 has been selected, it canbe interconnected with the bone replacing portion 1504. The lockingmember, such as the locking screw 1540, can be provided through theincision 1602 to lock the bone replacing member 1504 with thearticulating member 1510. Any appropriate driver, such as a hex headdriver 1620, can be provided to interconnect the bone replacing portion1504 with the articulating member 1510. The driver 1620 can be manual orpowered to assist in interconnecting or positioning the locking member1540.

Therefore, it will be understood that the distal radial replacement 1500can be interconnected with the radius 2 to replace a selected portion ofthe anatomy. Though the reasons for the positioning of the distal radialmember 1500 can be varied, a fracture can indicate positioning thedistal radial implant 1500 relative to the radius 2. As discussed above,the various modular portions can be provided in the kit 1590 to allowfor selection by a user of an appropriate geometry, size, orientationand the like.

Further, the modular portions of the distal radial implant 1500 canallow for easy revision or changing of the implant. Since the bonereplacement portion 1504 can be modular from the stem 1502 and thearticulating member 1510 can be modular from both the stem and the bonereplacing portion, the various portions of the implant 1500 can beindividually selected for implantation. Further, if a revision procedureis required or indicated, a user, such as a physician, can select to doa replacement of the articulating member 1510, the bone replacementmember 1504, or any appropriate portions and replace them with aselected other portions. For example, the articulating member 1510, thatcan initially be used or allowed to articulate with the natural bone ofthe carpal complex 6 and can be later replaced to articulate with thecarpal implant 50. Therefore, during a revision procedure, thearticulating member 1510 can be removed from the modular implant 1500and replaced with a portion that can articulate with the carpal implant.Further, during a revision or second procedure, the articulating membercan be replaced with a replacement articulating member of varyingconfigurations as selected by a user. Therefore, the modular implant1500 can allow for ease of revision procedure or for the intraoperativedetermination of an appropriate implant assembly.

In addition to the various modular assemblies discussed above, which canbe used in hemi- or total wrist arthroplasties, various other modularmembers can be used. The modular members can be included for variousreasons, such as fracture fixation, soft tissue fixation, bonereplacements, or any other appropriate purposes. As discussed above,various modular portions can be provided for bone replacement of aselected amount of bone depending upon the amount of bone that isresected or damaged. Further, various modular, semi-modular components,or single piece components can be provided for fracture fixation orstabilization.

With reference to FIG. 56, a distal humeral implant or system 2000 isillustrated. The distal radial implant 2000 can include a stem 2002,which can be any appropriate stem, such as the stem 1502, stem 1202, orany appropriate stem. It will be understood that the stem can besubstantially cylindrical, annular, polygonal, “I”-shaped, “T”-shaped incross-section, or the like. The stem 2002 can be fit or implanted into aselected bone portion, such as the radius 2, to assist in holding a bonereplacement section 2004 relative to the radius 2, as illustratedherein. The stem 2002 cannot only hold the bone replacement section 2004relative to the radius 2, but may also assist in anti-rotation, or thelike of the implant 2000. Also projections 2003, at any appropriateshape, size, etc., can be provided to extend from the bone replacementportion 2004 and engage the bone 2 (FIG. 57). One skilled in the artwill understand that an alternative projection portion 2003′ can also beprovided. The alternative projection 2003′ can include an outerdimension to engage a portion of the bone 2 and also in clued a regionto engage or receive the stem 2002. The projection 2003′ can be anyappropriate portion to engage the bone, including those taught above.One skilled in the art will also understand that more than a singleprojection can be provided.

The distal radial prosthesis 2000 can also include a flange member 2006.The flange member 2006 can be formed as a single piece with the bonereplacement portion 2004. Alternatively, the flange 2006 may becompletely or partially modular as discussed further herein. Inaddition, a flange or flange extension 2008 can be provided tointerconnect with the flange 2006 in any appropriate manner, includingthose discussed herein. The distal radial assembly 2000 can beinterconnected in any appropriate fashion and implanted into an anatomy,such as interconnected with the radius 2.

The bone replacement portion 2004 can include appropriate portions orsections. For example, the bone replacement portion 2004 can include anulnar articulation section 2010. The ulna articulation section 2010 canallow for articulation with the natural ulna 4, a prosthesis and/or agraft that are connected with the ulna 4. Further the bone replacementportion 2004 can include a carpal complex articulation section 2012. Thecarpal articulation region 2012 can articulate with a portion of thecarpal complex 6, a carpal bone replacement prosthesis, including thosediscussed above, and/or any other appropriate portion.

The bone replacement portion 2004 can also be provided in a plurality ofsizes. For example, the bone replacement portion 2004 can include aheight 2014 that can vary between a plurality of bone replacementportions and can be selected for various purposes. Further, as discussedabove, a modular member 2016 can be provided to interconnect with aproximal bone contacting side 2018 of the bone replacement portion 2004to assist in adjusting the height 2014 of the bone replacement portion2004 if only a single bone replacement portion 2004 is provided. Asdiscussed above, the distal radial prosthesis 2000 can be included in akit, such as the kit 1590. The kit 1590 can include the bone replacementportion 2004 in a plurality of sizes or include a plurality of theaugment members 2016. The augment members 2016 can be similar to theaugment member 1718 (FIG. 50) and perform a similar function. Forexample, the augment member 2016 can include a central aperture 2020 topass over a portion of the stem 2002. The augment 2016 can allow thestem 2002 to assist in positioning the augment portion 2016 relative tothe bone replacement portion 2004.

The bone replacement portion 2004 can be formed of any appropriatematerial, such as a metal, a metal alloy, a polymer, synthetic material,composite of metals, polymers, pyrolytic carbon, or other appropriatematerials. It will be understood that the bone replacement portion 2004,the stem 2002, the augment portion 2016, and the flange extension 2008,can be formed of any appropriate material. The bone replacement portion2004, however, can be formed partially or completely of a material thatis appropriate for articulation with the carpal complex 6 or the ulna 4.Any appropriate material can be used for this, such as an ultra highmolecular weight polyethylene, pyrolytic carbon, and other appropriatematerials.

The flange 2006 can be formed integrally or as a single portion with thebone replacement portion 2004. The flange 2006 can be also integratedinto the bone replacement portion 2004 in any appropriate manners, suchas welding, melding, melting, casting, forging, or the like. The varioustechniques can also include mechanical connections such as a screw orlatch. Nevertheless, the flange 2006 can include a connection section2022 that is formed near a selected portion of the flange 2006, such asan end thereof. The connection portion 2022 can be used to interconnectwith various members, such as the flange extension 2008, or with astructure to which the distal radial prosthesis 2000 is positioned. Forexample, a screw or other appropriate member can be passed through theconnection portion 2022 to connect to a selected portion of bone, suchas the radius, or the flange extension 2008.

The flange extension 2008 can be interconnected with the flange 2006 atthe interconnection portion 2022 for various purposes. For example, theflange 2006 may be provided in a substantially single length in the kit1590 or the kit 1590 may include a plurality of the flange extensions2008 of different sizes to allow for use in multiple or plurality ofdifferent situations. It will be understood that although the flange2006 can be provided in a plurality of lengths with a plurality of thebone replacement portions 2004, the flange extension 2008 can also beprovided to extend a length of the flange 2006 relative to the bonereplacement portion 2004 for various purposes.

The flange extension 2008 can include a flange interconnection portion2024 that can allow for interconnection of the flange extension 2008with the interconnection portion 2022 of the flange 2006. For example, abolt or flange connection screw 2026 can be provided to interconnect theflange extension 2008 with the flange 2006. Other appropriatemechanisms, such as a cotter pin, rivet, adhesive, ball joint, snap-fit,or the like may be used to interconnect the flange extension 2008 withthe flange 2006. Further, as briefly discussed above, the flange 2008can be provided in a plurality of sizes, such as in the kit 1590, to beselectively interconnected with the flange 2006 to achieve a selectivelength.

The flange extension 2008 can include or define bone connection portalsor apertures 2028 that can allow for interconnection of the flangeextension 2008 with a selected bone portion, such as the radius 2. Anappropriate bone connection member, such as a screw 2030 can be providedto interconnect the flange extension 2008 with the appropriate bonemember. The screw 2030 is merely exemplary and any appropriateconnection portion can be provided, such as a pin, a pop rivet, ananchor, a bolt, or any other appropriate connection member.

The bone connection apertures 2028 can be provided in any appropriatemanner, for example, the apertures 2028 can be threaded, smooth,partially threaded, countersunk threaded, or the like. Further, it willbe understood that the apertures 2028 can include machine threads toengage a machine thread portion of the screw 2030 while the screw 2030can include a shank 2032 that includes substantially bone-engagingthreads. It will be further understood that the screw 2030 caninterconnect with the apertures 2028 of the flange extension 2008 toassist in resisting or eliminating back out of the screw 2030.

The distal radial prosthesis 2000 can be used for any appropriatepurpose, such as for implantation into the radius 2, exemplaryillustrated in FIG. 57. It will be understood that the prosthesis 2000can be implanted in various embodiments in any appropriate bone portionor any appropriate bone segments and a distal radius 2 is merelyexemplary. As discussed above, the radius 2 can be prepared in anyappropriate manner, such as illustrated and discussed in relation toFIG. 53. Briefly, a selected portion of the distal radius can beresected, such as the distance 1612 and an appropriate size of the bonereplacement section 2004 or an appropriate combination of the bonereplacement section 2004 and the augment members 2016 can be selectedfrom an appropriate inventory, such as the kit 1590.

Once the appropriate distance 1612 has been resected of the radius 2 andthe appropriate bone replacement portion 2004 has been selected, theradius 2 may still include or be injured with a fracture 2040. Thefracture 2040 can be a fracture, such as a severely comminuted spiral,or diaphysal fracture. The fracture 2040 can be formed in the radius 2at any time, such as when the radius may have been injured, requiringthe distal radial implants 2000. The fracture 2040, however, may alsohave occurred after the initial procedure of implanting the prosthesis2000 when only a portion of the initial flange 2006 is included. Aflange or the flange extension 2008 can then be added at any appropriatesubsequent time. It will be understood, therefore, that the distalradial prosthesis 2000 can be used both for a primary and a revisionaryprocedure, depending upon the appropriate requirements. Nevertheless,the flange 2006 and/or the flange extension 2008 can be provided toextend a distance proximally along the radius 2 from the bonereplacement portion 2004. This may be selected, for example, if theextreme distal portion of the radius 2002 was unsalvageable, due to aninjury, disease, or the like. But a proximal portion of the radius 2 issalvageable, and includes a weakness or injury, such as a fracture 2040.The flange 2006 and flange extension 2008 can extend generally parallelto or at an angle to the longitudinal axis of the stem 2002.

The flange extension 2008 can be interconnected relative to the flange2006 in an appropriate manner. As discussed above, the flangeinterconnection mechanism 2026 can be used to interconnect the flangeextension 2008 with the flange 2006. At any appropriate time, the boneconnection screws 2030 can also be passed through selected portals 2028of the flange extension member 2008 or the flange 2006 to interconnectwith the radius 2. As illustrated, the bone screws 2030 can pass throughselected portions of bone, including the radius 2, to provide a fixationof the bone relative to the prosthesis 2000 and also provide for acompression force, such as to assist in healing.

The bone screws 2030 can pass through both a first portion 2A and asecond portion 2B of the radius 2 to span the fracture 2040 and assistin providing a compressive force relative to the portions 2A, 2B of theradius 2. Therefore, the fracture 2040 can be held and stabilized withthe bone screw 2030 and the flange 2006 or the flange extension 2008. Itwill be further understood that various soft tissue members can beinterconnected with the flange 2006, 2008, such as tendons, to assist infixing soft tissue relative to the prosthesis 2000, as one skilled inthe art will understand.

Further, a prosthesis system 2050, illustrated in FIG. 58, can beprovided to be more modular than the distal radial prosthesis 2000 andalso includes various beneficial features and similar features to theprosthesis 2000. With continuing reference to FIG. 58, the modularflange distal radial prosthesis 2050 can include portions substantiallysimilar to the distal radial prosthesis 2000, illustrated and describedabove. Various similar portions will be mentioned briefly, but notdescribed in detail.

The modular distal radial prosthesis 2050 can include a stem 2052 thatcan be provided in any appropriate length, cross-section or the like,such as those described above, Further, the modular distal radialprosthesis 2050 can include a bone replacement portion 2054. The bonereplacement portion 2054 can include portions or sections that aresimilar to the bone replacement portion 2004 discussed above. Forexample, the bone replacement portion 2054 can include an ulnaarticulation section 2056 and a carpal complex articulation section2058. It can also include projections 2055 to engage the radius 2. Asdiscussed above alternative projections, such as a projection section2055′ can be provided with the bone replacement section 2054. Also, astem engaging portion 2055′a can be provided in the projection section2055′. The projection 2055, 2055′ can be any appropriate portion toengage the bone, including those taught above. As discussed above morethan one projection section can be provided.

It will be understood that the articulation sections 2056, 2058 can besimilar to those described above or provided in any appropriate manner.Further, the bone replacement portion 2054 can be provided in anyappropriate manner or of any appropriate material. For example, the bonereplacement portion 2054 can include a height 2060 that can be variableor can be augmented with an augment section, such as the augment sectiondescribed above. A plurality of the bone replacement portions 2054 canbe provided in a kit, such as the kit 1059 in any appropriate size to beselected for a procedure, either pre- or intraoperatively. Also, thebone replacement portion 2054 can be formed of any appropriate material,such as a metal, metal alloy, polymer, pyrolytic carbon, or combinationsthereof or composites thereof.

The modular distal radial implant 2050 can also include a modular flangesection 2070. The modular flange section 2070 can include a flangeattachment portion 2072 and a flange attachment member 2074. The flangeattachment segments or members 2074 can be any appropriate member, suchas a screw. The flange attachment member 2074 can include a threadedshank 2076 and a head 2078. The head can define a drive section 2080,such as an internal hex drive segment. It will be understood that theflange attachment member 2076 can be any appropriate member and caninclude appropriate threads, such as including a single thread throughthe head 2078 or include a second thread segment on the head 2078 toengage a selected portion of the modular flange 2070.

The modular flange 2070 can also include a stabilization projection 2082that can engage a portion of the bone replacement member 2054. Thestabilization section 2084 can be provided in any appropriate manner,such as to resist rotation of the modular flange 2070, resist back outof the modular flange 2070, or any appropriate reason. The stabilizationsection 2084 can be keyed to a configuration of the stabilizationprojection 2082. The stabilization section 2084 can also be provided toallow for the movement of the flange 2080, as discussed further herein.The interconnection of the modular flange 2070 with the bone replacementportion 2054 will be discussed in further detail herein, but can beprovided to assist in positioning the modular flange 2070 relative tothe bone replacement portion 2054 as a part of the prosthesis assemblysystem 2050.

The modular flange 2070 can also include apertures 2090 to allow forpassage of connection members, such as bone screws 2092. The bone screw2092 can include a threaded shank 2094 and a head 2096, which caninclude an optional thread 2098. The apertures 2090 can receive thescrew 2092 to engage a bone portion, such as the radius 2 as describedabove. Therefore, the apertures 2090 can include internal threads 2100,if selected. The internal thread 2100 can assist in reducing back out ofthe screw 2092, increase interconnection of the screw 2092 with themodular flange 2070, or other appropriate reasons. Further, the threadson the shank 2094 and the threads on the head 2098 can be the same, ordifferent, such as a machine and a bone thread.

It will be understood that the modular flange 2070 can be provided in aplurality of lengths 2070L, widths 2070W, and thicknesses 2070T. Aselected modular flange 2070 can be provided or selected from the kit1590, or any other appropriate kit or stock, to be used with theprosthesis system 2050. Therefore, the prosthesis system 2050 can becustomized intraoperatively, preoperatively, or at any appropriate time.The prosthesis assembly 2050 can be used to replace a portion of theradius 2 for various reasons. Also, the flange 2070 can beinterconnected to the bone replacement portion 2054 during a revisionprocedure.

With reference to FIG. 58B, a prosthesis 2050′ similar to the prosthesis2050 is illustrated, thus substantially similar portions will bereferenced with the same reference numerals augmented by a prime. Theprosthesis 2050′ can include a flange 2070′ that is formed as a “U” or“V” or other generally open shape or configuration. The openconfiguration can be provided for various reasons. For example, theconnection bores 2090′ can be positioned a distance apart and/or awayfrom a center line of the prosthesis 2050′. Thus, the bone connectionmembers 2092′ can easily pass the stem 2052′ during implantation of theprosthesis 2050′.

In addition, the bone connection portals 2090, 2090′ can be formed toallow the bone connection members to converge or diverge relative to thestem 2052. One skilled in the art will understand that the direction ofthe bone connection members as they pass through the flange 2070, 2070′,2006, 2008 can be selected to be any appropriate angle and can beselected for various reasons. One skilled in the art will alsounderstand that the angle of passage can be selected according tovarious embodiments and any particular embodiment is merely exemplary.

Turning reference to FIG. 59B, the prosthesis according to variousembodiments, such as the modular prosthesis 2050 can include selectedportions. The flange 2070, or a flange according to various embodiments,can include connection sections 2071, which can be depressions orhollows in the flange 2070. It will be understood that bores can also beformed in the flange 2070 to act as the connection sections 2071. Theconnection sections 2071 can be used to capture or engage connectionportions 2073, such as cables. The connection portions 2073 can surroundthe bone 2 or other portions of the prosthesis 2050, such as a secondflange 2077. The connection portions 2073 can compress selected portionsfor stability and healing or repair.

In addition, the second flange member 2077 can be provided as a part ofthe prosthesis 2050. The second flange member 2077 can interconnect witha third flange member 2075 according to any appropriate connectionmechanism, including those discussed above. Further, a bone connectionmember 2079 can be provided to interconnect the second flange member2077 with the bone 2. The second flange 2077 and the third flange 2075can both be modular relative to the bone replacement portion 2054 or oneor both the second flange 2077 and the third flange 2075 can be formedas a single member with the bone replacement member 2054, combinationsthereof. Thus, one skilled in the art will understand that multipleflanges can be provided relative to the bone replacement member 2054 toprovide support to different or plural areas of the bone 2 or otherportions of an anatomy. For example, the flange 2070 and the secondflange 2077 can be provided substantially opposed to one another so thatthey can compress the bone 2 between them.

An exemplary method of implanting the prosthesis 2050 is illustrated inFIGS. 59A and 59B. The radius 2 can be resected according to anyappropriate method, including those described above and illustrated inFIGS. 52-54. The radius 2 can be prepared by resecting a selectedportion of the radius 2, such as a distal portion thereof by theselected distance 1612. The resected distance 1612 can be replaced withthe bone replacement portion 2054 of any appropriate height 2060. Thestem 2052 can be implanted in the radius 2 and interconnected with thebone replacement portion 2054 in any appropriate manner, such as withthe taper, a thread, a locking pin, a locking screw, or any otherappropriate interconnection. Although a selected portion of the distalradius 2 can be resected, the distal radius 2 may also include afracture 2150 that is not resected or replaced with the bone replacementportion 2054. The fracture 2150 can be stabilized, however, with use ofthe modular flange 2070 and the screws 2092 or other appropriateinterconnection member.

The modular flange 2070 can be interconnected with the bone replacementportion 2054 using the connection member 2074. The bone replacementportion 2054 can include a threaded bore 2152 that includes an internalthread 2154 that can interconnect or engage the threads of theconnection member 2074. As the connection member 2074 is driven, themodular flange 2070 can be moved in the direction of arrow 2160.

Once the attachment member 2074 has moved the flange 2070 relative tothe radius 2, the interaction of the flange 2070 with the bonereplacement portion 2054 and the stem 2052 can compress the radius 2 inan appropriate or selected manner. The compression of the flange 2070against the radius 2 can assist in stabilizing the prosthesis 2050,compressing the fracture 2150, or be provided for any other appropriatereason. Further, the screws 2092 can be passed through the flange 2070so that the shank 2094 can engage both a first side 2A and a second side2B of the radius 2 and can span the fracture 2150. By spanning thefracture 2150, the fracture 2150 can be further compressed orstabilized. The compression of the fracture 2150 can assist in healingof the fracture, maintenance of the integrity of the radius 2, or anyother appropriate reason. It will be understood that any appropriatenumber of screws 2092 or lengths of the screws 2092 can be provided withthe distal radial prosthesis assembly 2050. Providing one screw ismerely exemplary and provided for illustration purposes only.

Therefore, a modular flange, an integral flange, or a combinationthereof can be provided for various purposes as illustrated in FIGS. 56and 58. The flange can be a part of the prosthesis assembly that can beintegral or formed as a single piece with another portion of theprosthesis assembly or be provided as a completely separate member.Further, it will be understood that the prosthesis assembly, such as thedistal radial prosthesis 2000 and 2050 can be provided for both aninitial or primary and a revision procedure. For example, the flange canbe interconnected with a bone, such as the radius 2, at any appropriatetime, such as during a second or revision procedure. Further, thevarious prosthesis assemblies can be used with modular flange portionsto allow for installation of a flange member at a revision procedure.Thus, a completely one piece or modular system can be provided asselected.

A total wrist prosthesis assembly 2200, illustrated in FIG. 60, can beused to replace various portions of the anatomy. For example, a distalportion of the radius 2 can be resected and all or part of the carpalbones can be replaced. The total wrist prosthesis 2200, therefore, canreplace all or most of the carpal bones in the carpal complex orarticulate relative to them. The total wrist prosthesis 2200, however,can include multiple portions, as discussed further herein, such as astem 2202, bone replacement portion 2208, articulation portion 2212,carpal articulation portion 2220, and a bearing plate implant portion2240.

As discussed above, the carpal implant can be affixed relative toselected portions of the carpal bones of a carpal complex afterresecting and removing one or more of the bones in the carpal complex.The total wrist prosthesis 2200 can also be used for a total wristprosthesis or in conversion of a hemi-wrist prosthesis to a completewrist prosthesis. As discussed above, a hemi-wrist prosthesis can beused to replace a selected portion of the wrist, such as the distalradius or a portion of carpal complex, without replacing both sides ofthe articulating portion.

The various portions of the total wrist prosthesis 2200 can include thestem member 2202 that can be positioned in the radius 2. The stem member2202 can include a connection portion 2204, which can be threaded toengage a matingly threaded portion 2222. The stem member 2202 caninclude a stem portion 2206 that extends into the radius 2. The stemportion 2206 can be provided in any appropriate configuration such as anI-Beam, cylindrical, or the like, Various configurations can assist inreducing rotation or reducing the possibility of rotation of the stemwithin the radius 2. Further, the stem can be formed from anyappropriate material such as titanium, an alloy of cobalt chromium, analloy of cobalt chromium and molybdenum, stainless steels, or anyappropriate biologically compatible materials.

The body or bone replacement portion 2208 can be provided to bepositioned at the distal end of the radius 2. The distal end or resectedend of the radius 2 can be resected in any appropriate manner to engageor contact the body 2208. The body 2208 can include a passage orthroughbore 2210 to allow for the connection portion 2204 of the stem2202 to pass through and engage the articulation portion or member 2212.The body 2208 can also include a second passage or throughbore 2214 toallow for a connection portion or member 2216 to pass therethorugh andalso engage the articulating member 2212.

The articulation member 2212 can define an articulation or movingsurface 2218. The articulation surface 2218 can be provided toarticulate with a selected portion of the anatomy or the secondprosthesis, such as the carpal prosthesis 2220. The articulation surface2218 can also include a second or bone articulation surface 2218 a.Extending proximally from the articulation member 2212 can be anengagement or connecting portion. A stem connection portion 2222 caninclude a mating thread to engage the threads 2204 of the stem. A secondconnection portion 2224 can also include mating threads to engage thescrew 2216. The various connection portions can also be provided to matewith the body 2208 to allow for substantially tight tolerances once theyare connected. Also the connection portions 2222 and 2224 can allow fora single keyed or unique connection and configuration of thearticulation portion 2212, bone replacement portion 2208, and the stemmember 2202. It will be understood that such keying is not required, butcan be provided for various purposes (e.g. assembly efficiency andimplant efficiency).

The radial portion of the total wrist prosthesis 2200 can generallyinclude the stem 2202, the screw 2216, the body 2208, and thearticulation member 2212. According to various embodiments, the body2208 can be formed of a substantially solid and non-porous metal, aporous metal, a porous coated metal. As illustrated in FIG. 60, a body2208′, according to various embodiments, can be formed of or include aporous surface. The porous surface of the body 2208′ can assist withfixation of the body 2208′ to the anatomy, such as the radius 2. It willbe understood that over time, after implantation of the body 2208′, thedistal end of the radius 2 can grow into the porous surface of theporous body 2208′. The porous portion of the body 2208′ can include aporous coating; a porous metal portion (e.g. Regenerex™ Porous TitaniumConstruct sold by Biomet Manufacturing Corp.); porous metal portionsdisclosed in U.S. patent application Ser. No. 11/357,868, entitled“Method And Apparatus For Use Of Porous Implants” and in U.S. patentapplication Ser. No. 11/546,500, entitled “Method And Apparatus For UseOf Porous Implants”, both of these are incorporated herein by reference;or other appropriate porous portions. The body 2208, 2208′ can also beappropriately formed of U.H.M.W.P.E., ceramics, pyrolitic carbon,plastic, or polymers.

Further, the articulation member 2212 can also be formed of a metal orsubstantially hard material such as the same materials that form thebody 2208. Therefore, the portions of the radial portion of theprosthesis 2200 can be formed substantially of a metal or otherappropriate hard materials. Various metals can include titanium,stainless steels, alloys such as cobalt, chromium and molybdenum alloys,or any appropriate metals. The various metal portions can assist in afracture treating prosthesis. It will be further understood, the radialportion of the prosthesis 2200 can be any appropriate prosthesis, suchas those described above. Further, the various portions of the radialportion of the prosthesis 2200 can be assembled prior to implanting theminto the radius 2.

The prosthesis 2200 can also include the carpal complex prosthesis 2220.With continuing reference to FIG. 60 and additional reference to FIG.61, the carpal complex prosthesis 2220 can be formed as a single unitfrom modular components. For example, an articulation or bearing portion2230 can be molded onto or around an insert member 2232. The insertmember 2232 can include one or more protrusions 2234 that can engage aportion of the bearing portion 2230 to hold it securely relative to themetal insert portion 2232.

The bearing portion 2230 can be formed of any appropriate material suchas polyethylene, high molecular weight polyethylene, ceramics, forexample, the materials that can be used to form the body 2208 or anyappropriate material. Generally, the bearing portion 2230 can be formedof a material that can and is formed to articulate with the articulationsurface 2218 of the articulation member 2212. As discussed above, thearticulation member 2212 can be formed of a metal, thus the bearingportion 2230 can be formed of a polymer, plastic, ceramic, pyrocarbon(also referred to as pyrolytic carbon), or other appropriate materialfor articulating with the articulation member 2212 after implantation.

The metal insert 2232 can define a mating portion 2236 to mate with acomplementary mating portion 2238 of a carpal implant member 2240. Thecarpal implant member 2240 can include a surface or portion 2242 thatengages or is positioned next to one or more of the carpal bones in thecarpal complex. The carpal prosthesis 2240 can be interconnected withthe metal insert, such that the bearing member 2230 acts as a bearingportion for the carpal complex when articulating with the articulationmember 2212 of the prosthesis 2200. Therefore, the radial portion of theprosthesis 2200 can be formed or include a metal material as thearticulation portion 2212 and articulate with a polymer or similarmaterial that forms the articulation bearing 2230.

It will be understood that the carpal bearing portion 2220 can be usedwith an appropriate prosthesis, including those discussed above. Thecarpal bearing portion 2220 can include the polymer or similar bearingmember 2230 to articulate with a substantially hard, although smooth,articulation member. Further, it will be understood, that the carpalarticulation or bearing portion 2220 can be used to assist in convertinga hemi-prosthesis to a full prosthesis.

The attachment portion 2236 can be any appropriate attachment portionsuch as a mating locking taper, threaded, an adhesive, a receptacle orportion, or any appropriate connecting portion. Further, the body 2208can be provided in a kit, including the kits discussed above, to provideor include a plurality of heights. A height 2208 h of the body 2208 canbe selected based upon the amount of material to be resected from theradius 2. The portion of the radius 2 to be resected can depend upon theamount of fracture, disease, or the like of the radius 2 and, therefore,can be patient specific. Nevertheless, a kit can include a plurality ofthe bodies 2208 to allow for a substantially customized assembly andprosthesis during the procedure or intra-operatively.

As briefly described above, the various distal radial implant assembliesor members can be used in either a hemi-arthroplasty or a complete ortotal arthroplasty. For example, the distal radial implant assemblies1500, 2000, 2050, etc. can be used to simply replace a distal portion ofthe radius 2. In this manner, a hemi-arthroplasty of the wrist canoccur, which allows for maintenance of substantially the entire carpalcomplex. Alternatively, a substantial total wrist arthroplasty can beperformed. In the total wrist arthroplasty, not only can a portion ofthe radius be replaced, but a portion of the carpal complex 6 can alsobe replaced with a selected implant or prosthesis. Therefore, it will beunderstood that any of the implants discussed above are not limited toeither a total or a complete arthroplasty and can be provided in variouscombinations to allow for hemi-arthroplasty or a total arthroplasty.Further, the various implant portions can be selected to be alteredduring a revision procedure to allow for an alteration or changing of ahemi-arthroplasty to a total arthroplasty.

Alternatively, the carpal bearing portion 56 can also be provided tointerconnect or replace a portion of the carpal complex. For example,the connection portion 2238 can be interconnected with the taper orconnection portion 124. This can be selected when selecting between acomplete or hemi-wrist arthroplasty. Also, a radial implant is providedduring a hemi-arthroplasty procedure and later a total wristarthroplasty is selected the bearing portion 2220 can be selected forimplantation. In this manner the kit, such as the kit discussed above,can include both the bearing portion 56 and the bearing portion 2220,and any appropriate bearing member.

The various bearing portions 56, 2220 allow for selectionintra-operatively or pre-operatively for performing a procedure. Forexample, providing both of the bearing components allows for theselection of a soft bearing or articulation surface or a hardarticulation or bearing surface. Also, the selection can be madeintra-operatively based upon various considerations, such as experienceof a surgeon. Also, if a metal or hard radial implant is provided duringa first or primary procedure, during a revision procedure (which canoccur after the primary procedure is complete) the carpal portion 2220can be provided to move against the hard radial component.

Accordingly, while the description includes various embodiments asillustrated in the drawings, it will be understood by those skilled inthe art that various changes may be made and equivalents may besubstituted for elements thereof without departing from the scope of thedescription or the appended claims. In addition, many modifications canbe made to adapt a particular situation or material to the teachingswithout departing from the scope thereof. Therefore, it is intended thatthe teachings are not limited to any various embodiment illustrated inthe drawings and described in the specification as the best modepresently contemplated for carrying out the teachings herein, but thatthe teachings will include any various embodiments falling within theforegoing teachings and the appended claims.

1. A wrist prosthesis to replace at least a portion of a bone forming aportion of a wrist of a patient, comprising: a stem member extendingbetween a first end and a second end wherein the second end is operableto extend into a radius of the patient; and an articulation assemblyoperable to be interconnected with the stem member to replace a resectedportion of the radius, including: an articulation portion operable toarticulate with a carpal bearing portion, said articulation portiondefining a transverse elongated coupling depression; a stem connectionportion formed near the articulation portion to interconnect with thefirst end of the stem member to be held relative to the bone; a bonereplacement member operable to be positioned between the stem member andthe articulation portion; and a connection portion operable tointerconnect the bone replacement member and the articulation portion,the bone replacement member defining a bore annularly disposed about thestem connection portion and having a transverse elongated projectionconfigured to lockably engage with the transverse elongated couplingdepression; wherein the articulation portion is operable to form thearticulation assembly with the bone replacement member.
 2. The wristprosthesis of claim 1, wherein the bone replacement member is formed ofa substantially completely porous material, a substantially non-porousmaterial, a porous coated member, or combinations thereof.
 3. The wristprosthesis of claim 2, wherein the connection portion includes a secondconnection member.
 4. The wrist prosthesis of claim 2, wherein thearticulation portion includes a surface operable to articulate with atleast one of a carpal bone, a carpal implant, or combinations thereof.5. The wrist prosthesis of claim 1, wherein the bone replacement memberincludes a plurality of bone replacement members; wherein each of thebone replacement members includes a dimension different from the otherof the bone replacement members.
 6. The wrist prosthesis of claim 5,wherein the dimension includes a height, a width, a depth, a volume, orcombinations thereof.
 7. The wrist prosthesis of claim 1, furthercomprising: a carpal prosthesis portion including a metal inner portionand a bearing portion surrounding at least a portion of the metal innerportion operable to articulate with the articulation portion.
 8. Thewrist prosthesis of claim 7, wherein the articulation portion is formedof a metal or metal alloy and the bearing portion is formed of a polymermaterial.
 9. The wrist prosthesis of claim 1, wherein the articulationportion includes a first extension and a second extension that bothextend from the articulation portion; wherein the first extension andthe second extension engage the bone replacement member in a uniquemanner to allow the bone replacement member, the articulation portion,and the stem to interconnect in substantially a single configuration.